Scott Halpern, MD, PhD, and colleagues at the University of Pennsylvania found that when businesses add financial incentives to an offer for free smoking cessation aids, employees quit at a higher rate vs when offered free cessation aids alone. Click through the slides for details on their study and take home points for physicians.
Smoking Cessation and the Workplace. Studies have shown that for employees who already want to quit smoking, financial incentives help and over half of companies already offer financial incentives to their employees to quit smoking. However, Halpern and his colleagues wanted to determine if financial incentives could be effective for employees who are not interested in quitting smoking.
The Study. Usual care consisted of access to information about the benefits of smoking cessation and to motivational text-messages. All intervention groups received usual care, plus:
- Free cessation aid group received nicotine-replacement therapy or pharmacotherapy, with e-cigarettes if standard therapies failed.
- Free e-cigarette group did not have a requirement that standard therapies had been tried before.
- Free cessation aid group with reward incentive received $100, $200, and $300 if sustained smoking cessation at 1, 3, and 6 months after quitting and received an additional $600 for sustained abstinence.
- Free cessation aid group with redeemable deposits received $100, $200, and $300 if sustained smoking cessation at 1, 3, and 6 months after quitting and $600 in redeemable funds that was deposited in separate account. If participant did not meet cessation milestone requirements, money was removed from the account.
Results (All Participants):
- Redeemable deposits superior to free cessation aids (Odds ratio, 5.77; 95% CI, 2.66 to 12.50).
- Rewards superior to free cessation aids (Odds ratio, 3.95; 95%CI, 1.77 to 8.84).
- Redeemable deposits superior to free e-cigarettes (Odds ratio, 2.95; 95% CI, 1.52 to 5.71).
Results (Engaged Participants):
- Redeemable deposits superior to free cessation aids (Odds ratio, 4.85; 95% CI, 2.21 to 10.67) and to free e-cigarettes (Odds ratio, 2.93; 95% CI, 1.49 to 5.79;).
- Rewards superior to free cessation aids (Odds ratio, 3.47; 95% CI, 1.53 to 7.87).
- Approximately half the participants who sustained abstinence through 6 mos had negative biochemical assays at 12 mos.
Take Home Points:
- Workplace smoking cessation programs didn't work in unselected smokers who received usual care.
- Employee wellness programs that offer free cessation aids including e-cigarettes should be counseled that the approach is rarely successful.
- Offering financial incentives tripled the rate of smoking cessation and decreased employers' costs for each successful quit vs cessation aids only.
- Employee health programs should be advised that the overall cost of providing financial incentives for cessation will reflect savings vs the cost of employing smokers.
For more information: Halpern SD, Harhay MO, Saulsgiver K, et al. A pragmatic trial of e-cigarettes, incentives, and drugs for smoking cessation. N Engl J Med. 2018.Â