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 persuading people to quit smoking in workplace settings or elsewhere (Cochrane Database Syst. Rev. 2005; [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 also to 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 visit 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 partly 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–were too small to be of significance.
The next step in the study is to visit the employees again at 15 and 18 months to see what proportion remains abstinent in the absence of financial reward. The investigators also plan to evaluate the cost-effectiveness of undertaking such an initiative in employer-based settings.
During the question-and-answer period, Dr. Volpp noted that employers might derive even more benefit than would insurance companies from inducing employees to quit: The benefit to insurers would come strictly from lowered health care costs, but employers also could see gains in productivity because employees wouldn't be leaving the building to take smoking breaks during working hours.
ELSEVIER GLOBAL MEDICAL NEWS