Financial incentives can work wonders when it comes to encouraging smokers to kick the habit, but should we give people cash to quit tobacco?
Money talks when it comes to quitting ciggies. That’s the conclusion of new research which looked into whether financial incentives can help to boost quit rates.
The research, carried out by scientists at the University of East Anglia and published in the Cochrane Library in July 2019, set out to study whether rewards, such as money or vouchers - used in workplaces, in clinics and hospitals, and within community programmes - make people more likely to say goodbye to ciggies for good. Altogether, they looked at 33 randomised controlled trials involving 21,600 people from eight countries. The trials all followed up participants for at least six months and used reliable ways to check that people had actually given up fags, either using breath tests or urine or blood tests.
Dr Caitlin Notley, from UEA's Norwich Medical School, explained: “We wanted to know whether these schemes actually work long-term, as previously it was thought that perhaps incentives only worked for the time that they were given.”
What they found was that incentives made a big difference to outcomes. Dr Notley said: "We found that six months or more after the beginning of the trials, people receiving rewards were approximately 50 per cent more likely to have stopped smoking than those in the control groups.
"In people not receiving incentives, approximately seven per cent had successfully quit for six months or longer, compared to approximately 10.5 per cent of those receiving incentives.”
Vouchers for Quitting
This latest research backs up earlier studies which also found that financial rewards worked for smokers. A scheme run by Glasgow University in 2004 offered up to £400 worth of vouchers (which could be used at stores including Argos, Boots, Debenhams and Toys ‘R’ Us) to pregnant women.
The voucher scheme proved effective with mothers-to-be more than twice as likely to quit smoking.
Pay-offs for Mums
Since then many local councils have got in on the act. In South Tyneside, mums-to-be are eligible for up to £300 if they quit. Mum-of-three Laura McDonald praised the scheme, saying: “I gave up smoking during each of my pregnancies but then started smoking again afterwards. This time, I am determined to stay off cigarettes completely.”
In Scotland, some regions offer the Quit4U scheme which is available to any smoker providing free nicotine products, support from a pharmacy and £12.50 per week if they remain smoke-free.
Using rewards to help people improve their health is not a unique idea. In 2003, women in South Yorkshire and Derbyshire could earn up to £200 in shopping vouchers if they took part in a scheme to encourage breastfeeding.
And young people across the UK were offered the chance to win prizes like iPods in 2009 as part of an effort to get more of them to be tested for sexually transmitted disease chlamydia.
But health professionals are not entirely happy with the idea of this kind of transaction. While acknowledging the importance of pregnant women stopping smoking, Janet Fyle, professional policy advisor at the Royal College of Midwives (RCM) has said: “Incentivising public health behaviour change through monetary reward is not ideal.”
She added: “Alternative ways of stopping smoking in pregnancy also need attention, such as preconception care for those planning to get pregnant and midwives providing continuous antenatal advice and support to encourage women to quit smoking in pregnancy.
“Can we afford to incentivise behavioural change when the amount of potentially damaging lifestyle choices that people make could be almost limitless?”
Rewards at Work
For large companies, the trade-off between helping employees quit smoking (and other health concerns) is a no-brainer. According to research by the World Health Organisation (WHO) the overall economic costs of tobacco use in the UK to be £13.74 billion annually – which doesn’t just cover treatment of smoking-related illness but also loss of productivity due to illness and smoking breaks, increased absenteeism, the costs of cleaning up cigarette butts and fighting smoking-related fires, and the loss of economic output from people who die from diseases related to smoking or exposure to second-hand smoke.
No wonder, most large companies offer some kind of smoking cessation programme – and that may include incentive vouchers.
In the US, executives at General Electric (GE) put cigarette smoking near the top of their health care concerns, estimating that the company spent tens of millions of dollars each year on smoking-related illnesses.
They agreed to take part in a scheme with the University of Pennsylvania School of Medicine and Wharton School in 2005 to offer up to US $750 in incentives to smokers who took part in the trial. The results were very positive with participants giving up smoking at three times the rate of those in a control group.
But if a financial reward sounds like the best way to help support you to stop smoking – and your company doesn’t offer one – there is another route. Smokers are regularly recruited for clinical trials of smoking cessation therapies. Many pay very well.
So with a bit of research you could get someone to pay you to stop smoking while also providing the means. A win-win indeed.