Study: Modest incentives helped smokers quit
Dangling dollars dramatically boosts smokers’ likelihood of quitting, University of Texas researchers have found, a potential new strategy for cessation programs that struggle to attain results.
Smokers given the opportunity to earn a modest amount in gift cards kicked the habit at a rate more than twice that of those receiving standard treatment in a study of socioeconomically disadvantaged patients in Dallas. The study was published recently in the American Journal of Public Health.
“The conventional wisdom is that you have to pay a lot to get people to do things, but our study showed not that much is still very motivating,” said Darla Kendzor, a professor at the Dallas campus of UT Health Science at Houston’s School of Public Health and the study’s principal investigator. “Given smoking’s burden on health care, it’s hard to imagine that an incentive program like this wouldn’t be cost-effective for hospitals, clinics and other health institutions.”
Kendzor said the study was particularly encouraging because it was conducted in such a real-world setting, among people with the highest rates of smoking.
Bill Blatt, the American Lung Association’s nation- al director of tobacco programs, called for further study into the strategy with a larger population of smokers. He said incentive strategies can be controversial because “you don’t want to coerce people to quit — they need to decide for themselves.”
“But the people in this study were already motivated to quit, and the incentive was positive, not negative, so that’s all good,” Blatt said. “It’s definitely a promising study — these are real people in the real world.”
Despite significant strides in lowering rates over the past 50 years, smoking remains the most preventable cause of death and disease in the United States. According to the U.S. Centers for Disease Control and Prevention, smoking-related illnesses kill nearly a half million Americans a year and cost nearly $300 billion, between direct medical care and lost productivity.
Some 70 percent of smokers want to quit, according to surveys, but only 3 percent succeed in a given year.
Kendzor’s study enrolled 146 patients at Parkland Hospital’s smokingcessation clinic during 2011, 2012 and 2013. Nearly two-thirds were black, and more than half were uninsured and with an average annual household income of less than $12,000. Nearly 30 percent of people living in such poverty nationally smoke, compared to the overall rate of 18 percent.
Patients seeking treatment at the clinic were randomly assigned to either the standard care group — educational sessions, support-group meetings, physician visits and pharmacological treatment — or the intervention group, which received standard care, plus gift cards if they did not smoke. A Breathalyzer-like machine that measures carbon dioxide in the lungs confirmed whether patients had not smoked.
They could earn as much as $150 in Walmart gift cards, starting at $20 for the first quit date and earning additional cards the longer they stayed abstinent. On average, participants made $63.
Twelve weeks after the program began, 33 percent of those in the incentivized group had not smoked, compared to 14 percent of the other group.
Kendzor said what most surprised her was that women in the incentivized group fared best and women in the standard care group fared worst. She said there are numerous reasons women trying to quit fail — weight gain and depression, hormonal influences — but added it was unclear how incentives might counteract those factors.
Kendzor hopes to evaluate the study’s longer-term effects by following participants for six months or longer. She acknowledged concerns that patients may return to smoking after payments end — the incentivized patients’ quit rate dropped to 33 percent at 12 weeks after a fourweek quit rate of nearly 50 percent — but she said that was more likely to be true of those “not committed to quitting smoking.” Noting that researchers didn’t recruit people until they appeared at the clinic, she said the hypothesis was that “these people are motivated to begin with.”
“I definitely think this is a fruitful area, one that has potential widespread application,” Kendzor said. “The initial year of lung cancer treatment costs $70,000. How does $63 sound in comparison?” todd.ackerman@chron.com twitter.com/chron.com