Should we pay smokers to quit?

Should we pay people to stop smoking? The question is worth asking because of a trend towards offering incentives to people in smoking cessation programmes, including pregnant women.

In Christchurch, Smokefree Canterbury, a district health board service, is giving $50 shopping vouchers to pregnant smokers who attend an information session on how to give up. If they are not smoking four weeks later, they get an $80 voucher. If they stay smokefree until the end of their pregnancy, they get another $200 in baby store vouchers and a gift for themselves.

This is not a new idea, having been tried and tested overseas. Closer to home, a pilot programme for pregnant women was run in Counties-Manukau in 2013, offering $300 worth of incentives in total to people who managed to quit. Eighty-nine women enrolled in the programme and 50 of them were still not smoking after three months. After that success, similar reward programmes rolled out in other parts of the country, including Northland, Wairarapa, Palmerston North, Dannevirke, Nelson and Canterbury. Carbondioxide monitors are used to test whether participants are staying off tobacco.

How much does this cost? The Counties-Manukau scheme was estimated to cost $2000 for every woman who managed to give up smoking for four weeks. This was compared with five other previous (non-reward) schemes run nationally. It was equal to the cheapest of those, and a quarter of the cost of the most expensive.

Overseas studies also suggest that incentivised stop-smoking schemes are cost-effective in the longer term, by reducing the health system costs of the women and possibly their children further down the track. A scheme in Glasgow offered £400 ($700) worth of incentives to 600 women and found that 22.5 per cent of them were able to stop smoking, compared with only 8.6 per cent in non-incentivised programmes. These women were also less likely to take up smoking again after having their babies.

The higher success rates may not be just because rewards are being offered. On non-incentivised schemes, people who want to quit are commonly given advice and nicotine patches. On incentivised schemes, they get not only the rewards, but sometimes a ‘‘quit coach’’, return visits and regular monitoring, all of which keep them engaged with the programme.

Whatever the factors involved, evidence is building that these schemes are having some success in dealing with a significant public health issue. The rate of pregnant women still smoking is stuck stubbornly at around 15 per cent. This means that 9000 unborn children a year remain at a potential risk. Between 2006 and 2010, 86 per cent of cases of sudden unexplained death in infancy – what used to be called cot death – were attributed to smoking during pregnancy.

The reason likely to be given against offering rewards for people to give up smoking essentially involves a moral judgment – why should we pay people to do something they should be doing anyway, especially if the health of children is involved? But nicotine is a highly addictive substance, and giving it up is difficult. The Government wants New Zealand to be smoke-free by 2025, and time is running out. If these new approaches are shown to do good, and are judged to be cost-effective, why not use them? - Fairfax NZ