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A Randomized Controlled Trial of Financial Incentives for Smoking Cessation

¹ Center for Health Equity Research and Promotion and ² Primary Care and Consultative Medicine, Philadelphia Veterans Affairs Medical Center, University of Pennsylvania; ³ Division of General Internal Medicine, University of Pennsylvania; ⁴ Department of Health Care Systems, Wharton School, University of Pennsylvania; ⁵ Leonard Davis Institute of Health Economics, ⁶ Center for Clinical Epidemiology and Biostatistics, ⁷ Annals of Internal Medicine, and ⁸ Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; ⁹ Dana-Farber Cancer Institute; and ¹⁰ Harvard School of Public Health, Boston, Massachusetts

Requests for reprints: Kevin G. Volpp, CHERP, Philadelphia Veterans Affairs Medical Center, University and Woodland Ave., Philadelphia, PA 19104-6021. Phone: 215-573-0270; Fax: 215-573-8778. E-mail: volpp70{at}mail.med.upenn.edu

Background: Although 435,000 Americans die each year of tobacco-related illness, only 3% of smokers quit each year. Financial incentives have been shown to be effective in modifying behavior within highly structured settings, such as drug treatment programs, but this has not been shown in treating chronic disease in less structured settings. The objective of this study was to determine whether modest financial incentives increase the rate of smoking cessation program enrollment, completion, and quit rates in a outpatient clinical setting.

Methods: 179 smokers at the Philadelphia Veterans Affairs Medical Center who reported smoking at least 10 cigarettes per day were randomized into incentive and nonincentive groups. Both groups were offered a free five-class smoking cessation program at the Philadelphia Veterans Affairs Medical Center. The incentive group was also offered $20 for each class attended and $100 if they quit smoking 30 days post program completion. Self-reported smoking cessation was confirmed with urine cotinine tests.

Results: The incentive group had higher rates of program enrollment (43.3% versus 20.2%; P < 0.001) and completion (25.8% versus 12.2%; P = 0.02). Quit rates at 75 days were 16.3% in the incentive group versus 4.6% in the control group (P = 0.01). At 6 months, quit rates in the incentive group were not significantly higher (6.5%) than in the control group (4.6%; P > 0.20).

Conclusion: Modest financial incentives are associated with significantly higher rates of smoking cessation program enrollment and completion and short-term quit rates. Future studies should consider including an incentive for longer-term cessation. (Cancer Epidemiol Biomarkers Prev 2006;15(1):12–8)

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