Rewards Help but Peer Pressure Doesn't When Trying to Get Workers to Quit Smoking, Study Finds

Researchers from the University of Pennsylvania tested interventions on smokers who worked to quit either on their own or in teams, with different reward structures.

Offering cash incentives can encourage workers to quit smoking, but grouping them with fellow smokers to quit together made no difference in a study of more than 2500 CVS employees, who were given a variety of interventions to see what worked best to kick the habit.

The study, from authors at the Perelman School of Medicine at the University of Pennsylvania, was published late Wednesday in the New England Journal of Medicine. Researchers also found that giving employees free smoking cessation aids, such as nicotine patches, produced little difference in success rates.

Overall, the results point up what employers and policymakers already know: it’s really hard to get workers to quit smoking, although rewards have some success.

The study was funded by the National Cancer Institute, the National Institute on Aging, and CVS Caremark, which made news last year when it took all tobacco products out of its stores. The study was designed to see which of several different interventions was most effective in getting employees and their families to stop smoking. All 2538 participants received usual care, which included smoking cessation guides from the American Cancer Society. In addition, all but a control group of the received an intervention:

· Participants in two groups worked individually to quit smoking. They could earn up to $800, earned in installments, if a test confirmed they had not been smoking at 14 days, 30 days and 6 months after their quit date.

· A second group working as individuals had to deposit $150 at the start of the intervention, which would be returned along with the bonus payments earned for “clean” tests at the installments.

· Two other sets of participants had similar interventions, but they were organized in groups of 6 with similar quit dates. Payments to group members increased from $100 each time if only 1 person passed the test, to $600 if every team member passed. A web-based chat room was set to encourage support and collaboration.

· The second group-based intervention featured the $150 deposits from each group member, plus a $450 matching reward for each group member who quit at each time point.

Of the 2070 participants who took part in the interventions, those taking part were overwhelmingly more likely to accept the reward-only model (90%) than the one that required a deposit that would be lost if the smoker failed to quit (13.7%). Acceptance of the individual or group method was evenly split, with a combined acceptance rate of 51.9%.

At 6 months, the share of participants with sustained abstinence from smoking was greater with the reward-based incentives (15.7%) than with the deposit-based incentives (10.2%), and was similar between individual and group participants, 12.1% vs 13.7%.

Of note, however, 52.3% of those who willingly accepted the deposit-based intervention had sustained abstinence at 6 months; the problem, of course, is that a much smaller share of smokers preferred this option, which makes it impractical for employers to impose on workers.

Reference

Halpern SD, French B, Small DS, et al. Randomized trial of four financial-incentive programs for smoking cessation [published online May 13, 2015]. N Engl J Med. DOI: 10.1056/NEJMoa1414293