Way to Quit
Scott Halpern, MD, PhD
Kevin Volpp, MD, PhD
National Cancer Institute
National Institute on Aging
Although national policies, behavioral programs, and pharmacologic approaches have helped reduce smoking rates in the United States, it remains the leading cause of preventable illness and death.
A team of researchers from the University of Pennsylvania leveraged Way to Health to test multiple incentive models to discover which version would deliver the highest smoking cessation rates sustainably.
Approximately 2,500 CVS Caremark employees and their relatives and friends were enrolled in the study. Participants were randomly assigned to one of four incentive programs or to usual care for smoking cessation. Incentives were provided for six months, and nicotine or anabasine concentrations were measured at 14 days, 30 days, six months, and 12 months after the target quit date to assess quit rates.
Two of the incentive programs targeted individuals and two targeted groups. One of the individual-oriented programs and one of the group-oriented programs offered rewards of approximately $800 for smoking cessation. The others provided refundable deposits of $150 of the participant's own money plus $650 in reward payments if they completed the program successfully. Usual care consisted of informational resources and free smoking cessation aids.
Of the participants assigned to the four incentive arms, 90 percent were willing to enter a reward-based incentive program, but only 14 percent were willing to accept a deposit-based program. Acceptance rates for individual and group incentives were roughly the same, around 51 percent.
All four incentive programs yielded greater rates of sustained abstinence from smoking at six months compared to usual care. In addition, quit rates were nearly triple for those in the deposit-based program than for those in the reward-based program at all times, even after adjusting for a much higher propensity of deposit participants to quit smoking. However, deposit-based incentives – at least with the $150 deposit amount used – were deemed less effective overall because of the lower acceptance rate. Group-oriented reward programs and individual-oriented ones were similarly effective for smoking cessation.
Further analysis of participants suggests that, because of heterogeneity among smokers in their acceptance and response to different kinds of incentives, employer incentives could optimize interventions by offering more individualized incentive programs based on employee characteristics.