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To sustain smoking abstinence: need of financial incentives, added to free cessation aids

by Eugenio Greco, Prevention, Epidemiology & Population Science Section

Tobacco


Smoking remains the leading cause of preventable illness and death in the United States, and many U.S. companies offer smoking-cessation programs for their employees because smokers cost the companies several thousand dollars more than non-smokers per year. Nearly half of those companies offer financial incentives for employees who successfully stop smoking, and the benefits offered by smoking-cessation programs vary considerably; there is limited evidence regarding the absolute or comparative effectiveness of these programs.Smoking remains the leading cause of preventable illness and death in the United States, and many U.S. companies offer smoking-cessation programs for their employees because smokers cost the companies several thousand dollars more than non-smokers per year. Nearly half of those companies offer financial incentives for employees who successfully stop smoking, and the benefits offered by smoking-cessation programs vary considerably; there is limited evidence regarding the absolute or comparative effectiveness of these programs.

Previous randomized, controlled trials involving employees who were interested in quitting smoking showed that financial incentive programs of approximately $800 tripled the rates of abstinence through 6 months as compared with approaches that offered only free access to behavioural-modification programs and informational resources, but some key questions remained unanswered. The authors Scott D. Halpern, et al. (1) conducted the current trial to address these key questions.

They conducted a randomized, controlled trial that compared five approaches to smoking cessation: usual care and four interventions designed to promote sustained smoking abstinence.

In the first phase, 2229 eligible participants from 9 companies were identified in October 2014. In the second phase, 3902 eligible participants from 45 companies were identified in November 2015. The second phase was launched because the target sample size was not met in the first phase.Smokers employed by 54 companies were assigned to one of four smoking cessation interventions or to usual care:

  1. Usual care consisted of access to information regarding the benefits of smoking cessation and to a motivational text-messaging service.
  2. The four interventions consisted of usual care plus:
  1. Free cessation aids (nicotine-replacement therapy or pharmacotherapy, with e-   cigarettes if standard therapies failed)
  2. Free e-cigarettes, without a requirement that standard therapies had been tried
  3. Free cessation aids plus $600 in rewards for sustained abstinence
  4. Free cessation aids plus $600 in redeemable funds, deposited in a separate account for each participant, with money removed from the account if cessation milestones were not met.

The primary outcome was sustained smoking abstinence for 6 months after the target quit date.

The results were that among all smokers who were invited to enrol, 6006 underwent randomization.Sustained abstinence rates through 6 months were 0.1% in the usual-care group, 0.5% in the free cessation aids group, 1.0% in the free e-cigarettes group, 2.0% in the rewards group, and 2.9% in the redeemable deposit group.

The conclusions of the authors of this trial were that with respect to sustained abstinence rates, redeemable deposits and rewards were superior to free cessation aids, and were superior to free e-cigarettes: the offer of free e-cigarettes does not result in higher rates of sustained abstinence than traditional smoking-cessation aids and does not increase abstinence rates among smokers who are also offered information and motivational text messages; free e-cigarettes were not superior to usual care or to free cessation aids. 

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology

References

Eugenio Greco commented on this article:

  1. A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation
    Scott D. Halpern, et Al.
    N Engl J Med 2018;378:2302-10. DOI: 10.1056/NEJMsa1715757