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Background Smoking is the leading preventable cause of premature death in the United States. Previous studies of financial incentives for smoking cessation in work settings have not shown that such incentives have significant effects on cessation rates, but these studies have had limited power, and the incentives used may have been insufficient.
Methods We randomly assigned 878 employees of a multinational company based in the United States to receive information about smoking-cessation programs (442 employees) or to receive information about programs plus financial incentives (436 employees). The financial incentives were $100 for completion of a smoking-cessation program, $250 for cessation of smoking within 6 months after study enrollment, as confirmed by a biochemical test, and $400 for abstinence for an additional 6 months after the initial cessation, as confirmed by a biochemical test. Individual participants were stratified according to work site, heavy or nonheavy smoking, and income. The primary end point was smoking cessation 9 or 12 months after enrollment, depending on whether initial cessation was reported at 3 or 6 months. Secondary end points were smoking cessation within the first 6 months after enrollment and rates of participation in and completion of smoking-cessation programs.
Results The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment (14.7% vs. 5.0%, P<0.001) and 15 or 18 months after enrollment (9.4% vs. 3.6%, P<0.001). Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program (15.4% vs. 5.4%, P<0.001), completion of a smoking-cessation program (10.8% vs. 2.5%, P<0.001), and smoking cessation within the first 6 months after enrollment (20.9% vs. 11.8%, P<0.001).
Conclusions In this study of employees of one large company, financial incentives for smoking cessation significantly increased the rates of smoking cessation. (ClinicalTrials.gov number, NCT00128375
[ClinicalTrials.gov]
.)
Source Information
From the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center (K.G.V., D.A.A.); the Center for Health Incentives, Leonard Davis Institute of Health Economics (K.G.V., A.B.T., M.V.P., H.A.G., D.A.A., J.Z., J.D., J.W.), the Department of Health Care Management, the Wharton School (K.G.V., M.V.P., H.A.G., A.P., D.A.A.), and the Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology (A.B.T., F.W.), University of Pennsylvania; the Department of Medicine (K.G.V., H.A.G., D.A.A., J.Z., J.D., E.C.) and the Transdisciplinary Tobacco Use Research Center, Department of Psychiatry (J.A.-M.), University of Pennsylvania School of Medicine — all in Philadelphia; General Electric, Fairfield, CT (R.G.); and Yale University School of Medicine, New Haven, CT (R.G.).
Address reprint requests to Dr. Volpp at the Division of General Internal Medicine and Department of Health Care Management, University of Pennsylvania School of Medicine and the Wharton School, 1232 Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104-6021, or at volpp70{at}wharton.upenn.edu.
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