Volpp KG (CHERP)
Gurmankin A (Harvard Sch of Public Health)
Asch DA (CHERP)
Murphy J (Philadelphia VAMC)
Berlin J (University of Pennsylvania)
Gomez A (University of Pennsylvania)
Zhu J (University of Pennsylvania)
Lerman C (University of Pennsylvania)
Approximately 70 percent of smokers want to quit smoking, but only about 3 percent of smokers quit each year. Smoking cessation programs are an underutilized cost effective way to help people quit smoking. Our objective was to determine whether modest financial incentives increase the rate of smoking cessation program enrollment, completion, and quit rates.
179 patients at the Philadelphia Veterans Affairs Medical Center who reported smoking at least 10 cigarettes per day were randomized into incentive and non-incentive groups. Both groups were invited to join a 5-class smoking cessation program at no out-of-pocket cost. In addition, the incentive group was offered $20 for each class attended and $100 if they quit smoking (biochemically confirmed). Subjects were blinded as to the existence of the other group. Intention to treat analysis was used for each of the outcome variables. Chi-Square tests were used to test for significant differences in enrollment and completion between the two groups.
Subjects had smoked an average of 29.8 years, with a mean consumption of 23.4 cigarettes per day. There were no significant differences between the incentive and enrollment groups in the number of cigarettes smoked per day, the length of time patients had been smoking, degree of addiction, quitting intentions, risk perception of smoking-related risks, sociodemographic characteristics, and distance from the VA hospital. The incentive group had higher rates of program enrollment (43.3% vs. 20.2%, p<.001) and program completion (25.8% vs. 12.2%, p=.02). Data on quit rates 30-days post-program completion showed significantly higher tobacco cessation rates in the incentive group than in the control group (16.3% vs. 4.6%, p<.001). Effects were larger among heavy smokers (p=.04). 6 month follow-up data showed quit rates of 6.5% in the incentive group and 4.6% in the control group (p-value, .57).
Modest financial incentives achieved significantly higher rates of smoking cessation program enrollment, program completion, and 30-day quit rates. Payment of incentives beyond the first 30 days appears to be necessary to achieve increases in longer-term quit rates.
The use of financial incentives could be an effective and cost-effective strategy for reducing the burden of tobacco-related illness within the VA.