Randomized trial of four financial-incentive programs for smoking cessation
Open accessAbstract
BACKGROUND: Financial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain. METHODS: We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids. RESULTS: Overall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P=0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program. CONCLUSIONS: Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs. (Funded by the National Institutes of Health and CVS Caremark; ClinicalTrials.gov number, NCT01526265.).
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Studies of financial rewards for weight loss or tobacco cessation yield initial benefits that wane over time.
“For example, studies of financial rewards to incentivize behavioral changes, such as weight loss or tobacco cessation, yield initial benefits that invariably wane precipitously over time80,81.”
From Maintenance of Lost Weight and Long-Term Management of Obesity (2018) · cites this paper as [80]
The Results (Effectiveness and Costs of Interventions) report that roughly half of those abstinent at six months submitted negative cotinine assays at 12 months, supporting a decline in documented abstinence after incentives ended. But the paper does not support 'invariably': reward-based programs remained superior to usual care at 12 months. The Discussion also describes unsustained early benefits in weight-loss trials specifically for group-oriented versus individual-oriented payments, not financial rewards generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredLonger-term sustained motivation is more likely when patients take ownership of behavioral changes and goals and engage in them because they are deeply meaningful or enjoyable.
“longer term sustained motivation is more likely when patients take ownership of their behavioral changes and goals, and engage in them because they are deeply meaningful or enjoyable80,81.”
From Maintenance of Lost Weight and Long-Term Management of Obesity (2018) · cites this paper as [80]
The Results report sustained smoking abstinence under financial-incentive programs, and the Discussion attributes a possible behavioral effect of deposits to loss aversion. Neither section addresses whether taking ownership of goals or finding a behavior meaningful or enjoyable makes long-term motivation more likely; searches for those concepts found no supporting passage in our copy. (LLM, conf=0.74)
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- Authors
- Halpern, S. D., French, B., Small, D. S., Saulsgiver, K., Harhay, M. O., Audrain-McGovern, J., Loewenstein, G., Brennan, T. A., Asch, D. A., & Volpp, K. G.
- Affiliations
- University of Pennsylvania Health System (US)
- Leonard Davis Institute of Health Economics (US)
- CVS Health (United States) (US)
- Philadelphia VA Medical Center (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2015-05-28
- Volume
- 372
- Issue
- 22
- Pages
- 2108-2117
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4471993
- OpenAlex
- W259184059
- Cited by
- 379
- References
- 46
- Citations by year
- 2026: 17 · 2025: 28 · 2024: 22 · 2023: 20 · 2022: 31 · 2021: 39 · 2020: 41 · 2019: 37 · 2018: 42 · 2017: 35 · 2016: 43 · 2015: 21 · 2012: 1
- FWCI
- 34.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ScholarlyCommons (University of Pennsylvania) (submittedVersion)
- Funders
- National Institute on Aging (P30AG034546, RC2AG036592)
- National Cancer Institute (R01CA159932)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- smoking cessation, financial incentives, reward-based incentives
- MeSH terms
- Adult, Female, Group Processes, Humans, Male, Middle Aged, Motivation, Reward, Smoking Cessation
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