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Deposit-based smoking cessation programs more effective than reward-based programs

Although reward-based programs for sustained abstinence from smoking were more likely to be accepted by participants, deposit-based programs were significantly more effective, according to study results.

Group-oriented incentive programs were no more effective than individual-oriented incentive programs, Scott D. Halpern, MD, PhD, of the departments of medicine biostatistics and epidemiology and the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote.

Although financial incentives have been shown to promote health behaviors, effective ways to deliver health incentives are not quite as clear. For this reason, between February 2012 and October 2012, Halpern and colleagues randomly assigned 2,538 employees of CVS Caremark and their family and friends to one of two incentive programs targeting individuals, one of two incentive programs targeting groups of six participants or to usual care for smoking cessation. Participants were aged at least 18 years, reported smoking at least five cigarettes per day, had access to the Internet and stated an interest in smoking cessation.

Rewards of approximately $800 were given for smoking cessation for one of the individual-oriented programs and one of the group-oriented programs. All other programs offered refundable deposits of $150 plus $650 in rewards for those who successfully completed the program. Participants assigned to usual care were given informational resources and free smoking cessation aids.

Results indicated that compared with 13.7% of those assigned to deposit-based programs, 90% of those assigned to reward-based programs accepted the assignment (P<.001). The 6-month rates for sustained abstinence from smoking were higher for all four incentive programs (range, 9.4%-16%) vs. usual care (6%; P<.05 for all comparisons).

Similarities were observed in 6-month abstinence rates among those assigned group-oriented (13.7%) and individual-oriented programs (12.1%; P=.29). Reward-based programs led to higher abstinence rates (15.7%) compared with deposit-based programs (10.2%; P<.001).

Yet, when the researchers accounted for differential acceptance in instrumental variable analyses, they observed an estimated 13.7% higher 6-month abstinence rate (95% CI, 3.1-22.8) for those assigned deposit-based programs vs. reward-based programs.

In an accompanying editorial, Cass R. Sunstein, JD, of Harvard University, wrote: “There are implications for both future research and public policy. With respect to research, it would be valuable to know whether a smaller deposit might increase participation without reducing efficacy. With respect to public policy, deposit programs, which enlist loss aversion, are the better way to help people to quit smoking. The challenge is to find a way to nudge people to enroll in such programs. If that challenge cannot be met, reward programs are much better bets.”

Disclosure: The study was supported by grants from the NCI, the National Institute on Aging and CVS Caremark. The researchers report no relevant financial disclosures.