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Volume 41, Issue 10, Page 1 (15 May 2008)
http://www.internalmedicinenews.com/article/PIIS1097869008705468/fulltext
Payments Promote Smoking Cessation
MIRIAM E. TUCKER (Senior Writer)
PITTSBURGH — Financial incentives for smoking cessation offered by employers in large workplace settings succeed in getting employees to quit, the findings from a government-funded study suggest.
The subject is controversial. Two 2005 Cochrane reviews concluded that the evidence did not support the efficacy of incentives —including financial ones—in convincing people to quit smoking in workplace settings or elsewhere (Cochrane Database Syst. Rev. 2005 [Epub
doi:10.1002/14651858.CD004307 and doi:10.1002/14651858.CD003440]).
But, according to Dr. Kevin G. Volpp, most of the studies examined were underpowered and/or offered insufficient incentives —in some cases as little as $10. "The Cochrane review should have concluded that the things that have been tried to date haven't worked, not that this can't work if properly tested," Dr. Volpp of the University of Pennsylvania, Philadelphia, said at the annual meeting of the Society of General Internal Medicine.
He is the principal investigator for a randomized, controlled study funded by the Centers for Disease Control and Prevention in which 878 regular smokers (five or more cigarettes/day) employed by General Electric Co. received information about local community-based smoking cessation resources and coverage of prescription drugs and physician visits for smoking cessation. Of those, 436 were randomized to also be offered the incentives of $100 for completing a smoking cessation program, another $250 for quitting smoking by either the 3rd or 6th month after study enrollment, and another $400 for continuous abstinence between the 6- and 12-month follow-up visits. Cotinine tests were done at each of the visits to verify abstinence.
During the first 6 months, 9% of the incentive group completed smoking cessation programs, compared with just 1% of the controls, a highly significant difference. Quit rates in the first 6 months also were significantly higher for those offered incentives, 23% vs. 13%. The proportions of the two groups that had quit by 12 months, the study's primary end point, were 15% and 6.5%, respectively, again a highly significant difference.
Moreover, the relapse rate between 6 and 12 months was significantly lower for the incentive group than for the controls, most likely because the largest dollar amount was offered for the 12-month end point, Dr. Volpp said.
The success of the intervention appeared to be influenced partially by the incentive to enroll in a smoking cessation program. Among all study participants who completed such programs, quit rates at 12 months were 47% for the incentive group and 15% for the controls.
Among those who did not participate in a program, 9.5% and 6%, respectively, remained abstinent at 12 months. However, though getting people to enroll in programs did appear to help, most of the subjects who quit did not participate in them, Dr. Volpp said.
The incentives appeared effective regardless of the number of times the employee had tried to quit in the past. The incentives also were at least somewhat effective in those who smoked two packs or more per day, although those numbers —2 of 22 such smokers who received incentives had quit at 12 months, compared with 0 of 20 controls—
http://www.sgim.org/index.cfm?pageId=683
Here's an earlier study, at the VA. -G]
http://www.ncbi.nlm.nih.gov/pubmed/16434580
Cancer Epidemiol Biomarkers Prev. 2006 Jan;15(1):12-8
A randomized controlled trial of financial incentives for smoking cessation.
Volpp KG, Gurmankin Levy A, Asch DA, Berlin JA, Murphy JJ, Gomez A, Sox H, Zhu J, Lerman C.
CHERP, Philadelphia Veterans Affairs Medical Center, University and Woodland Ave., Philadelphia, PA 19104-6021, USA.
volpp70@mail.med.upenn.edu
BACKGROUND: Although 435,000 Americans die each year of tobacco-related illness, only approximately 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 non-incentive 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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