Cited by 379Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesBehavioral Health and Interventions

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Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation

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Halpern, Scott D., French, Benjamin, Small, Dylan S., Saulsgiver, Kathryn, Harhay, Michael O., Audrain-McGovern, Janet, Loewenstein, George, Brennan, Troyen A., Asch, David A., Volpp, Kevin G.·2015·New England Journal of Medicine

DOI 10.1056/nejmoa1414293PMC PMC4471993

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Abstract

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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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: Halpern, Scott D.
French, Benjamin
Small, Dylan S.
Saulsgiver, Kathryn
Harhay, Michael O.
Audrain-McGovern, Janet
Loewenstein, George
Asch, David A.
Volpp, Kevin G.
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
DOI: 10.1056/nejmoa1414293
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
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 › Public Health, Environmental and Occupational Health › 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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Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation

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