Is money even more enticing to smokers than cigarettes?
This was the question at the heart of a new study from the University of Pennsylvania, published this week in the New England Journal of Medicine. In an effort to evaluate financial-incentive smoking-cessation programs, researchers looked at four different models of such initiatives in a clinical trial of more than 2,500 randomly assigned CVS Caremark employees and their relatives and friends.
One option allowed smokers to deposit, or "bet," $150 of their own money -- and only recoup it, along with a bonus, if they changed their behavior -- while another simply paid smokers who successfully quit. Another system put smokers into groups, and either offered higher rewards if more members of the group quit or gave successful quitters the deposits of group members who didn't kick their habit. The reward across all four programs was capped at $800. A separate control group received "usual care," which included counseling, information about the dangers of smoking and smoking cessation aids like nicotine patches.
People were much more likely to agree to take part in the reward-based programs -- 90 percent of participants who were asked to enroll in the plan said yes -- than the deposit-based ones, which had a 13.7 percent enrollment rate. And though participants were less likely to accept the deposit-based program, it yielded more success stories: 52.3 percent of participants who bet on themselves successfully abstained from smoking after six months, while only 17.1 percent of people in the reward-based program did.
Group-oriented rewards programs, the study reported, were not significantly more effective than individual-oriented ones.
Overall, all the financial incentive programs were more effective than usual care -- with a 15 to 16 percent sustained abstinence rate at six months, compared to 6 percent -- which, researchers argue, offers an important message for employers to consider.
"Because employing a smoker is estimated to cost $5,816 more each year than employing a nonsmoker, even an $800 payment borne entirely by employers and paid only to those who quit would be highly cost-saving," the study says.
As The New York Times notes, the study was the largest to date that has considered financial-incentive smoking-cessation programs. CVS intends to use the research findings to design a plan to get their own employees to quit smoking.
Still, there are caveats -- and challenges for any business hoping to adopt a smoking-cessation program -- associated with this promising research. The most effective program in the study was not particularly popular, after all. As Cass R. Sunstein, founder and director of Harvard University’s Program on Behavioral Economics and Public Policy, wrote in a NEJM editorial, the test will be making deposit programs more attractive to smokers who are attempting to quit.
“If that challenge cannot be met, reward programs are much better bets,” Sunstein wrote.
Cigarette smoking among U.S. adults has hit a record low -- as of 2013, about 17.8 percent of American adults smoke cigarettes, compared to 20.9 percent in 2005 and 42.4 percent in 1965.
Still, the Centers for Disease Control and Prevention warned last year that the anti-smoking push is falling short of the federal goal of reaching a smoking rate of 12 percent by 2020 and the National Institutes of Health reports that smoking is still responsible for about 443,000 deaths each year.