Paying smoker to quit with payments that increased with the length of abstinence led to one third of participants to stop smoking for six months, according to research published Aug. 15 in the special Cardiovascular Health Promotion issue of the Journal of the American College of Cardiology.

The Swiss study, led by Jean-François Etter, PhD, included 805 low-income smokers who indicated they were motivated to quit. Researchers randomly assigned 401 participants to the incentive group and 404 to a control group, verifying smoking status with biochemical tests throughout the study. Participants – who smoked about 16 cigarettes a day – were provided booklets and access to a website with information about smoking cessation. The incentive group received frequent rewards for confirmed abstinence, with rewards increasing incrementally after three months, totaling as much as $1,500.

Results showed that at three months, 44.4 percent of the smokers in the incentive group reported they had been abstinent continuously compared to 6.4 percent of the control group. At six months, 35.9 percent of the incentive group and 5.7 percent of the control group reported continuous abstinence. At 18 months, which was one year after incentive payments ended, 9.5 percent of the incentive group and 3.7 percent of the control were confirmed abstinent.

The authors conclude that while a large group relapsed after payments ended, abstinence rates a full year after the last incentive were almost 6 percentage points higher among smokers who received financial incentives compared to those who did not.

In an accompanying editorial comment, Joseph A. Ladapo, MD, PhD, and Judith J. Prochaska, PhD, MPH, determine that it will cost $28,050 to yield one additional long-term quitter and question who will pay for this initiative. They add that the findings “provide important information about incentive effectiveness, generalizability, and durability.” They explain that although participants in the study were largely ready to quit, incentives may prove useful for engaging unmotivated smokers in quitting. “Future work should aim to bridge critical knowledge gaps concerning incentive design and delivery, and ultimately, inform the comparative effectiveness of financial incentives relative to other clinical and behavioral approaches to treating nicotine addiction,” they conclude.

Keywords: Control Groups, Health Promotion, Motivation, Nicotine, Pamphlets, Poverty, Reward, Smoke, Smoking, Smoking Cessation, Tobacco Use Disorder

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