February 15, 2009
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February 15, 2009
Offering hard, cold cash to smokers to spur them to stop their unhealthy habit helps more people give up cigarettes, new research finds. The study, published in the Feb. 12 issue of the New England Journal of Medicine, included a large group of General Electric Co. employees across the country who were offered up to $750 to give up smoking. After about a year, 14.7 percent of the group that was offered money were still smoke-free, compared to just 5 percent of those who weren’t paid to kick the habit.
“Incentives do work in changing health behaviors, and they can be successful in people who have not succeeded using other approaches in the past,” said study author Dr. Kevin Volpp, director of the Center for Health Incentives at the University of Pennsylvania School of Medicine and the Wharton School in Philadelphia.
Even though just 15 percent of those offered money ended up quitting for the long term, those success rates are still far higher than what’s normally seen in smoking-cessation efforts.
“Only about 2 to 3 percent of smokers quit each year,” said Thomas Glynn, director of cancer science and trends and international cancer control for the American Cancer Society.
Yet, as many as 70 percent of people who smoke report wanting to quit, according to background information in the study. Meanwhile, smoking remains the leading preventable cause of premature death in the United States.
“Four hundred and thirty-eight thousand [people] die in the U.S., and globally about 5 million people die each year from tobacco use. At any given time, about 9 million people are ill from tobacco use, and tobacco is associated with the development of 15 cancers,” Glynn said.
Almost 900 GE employees were recruited for the study, and half were assigned to the incentive program, while the other half was a control group. The employees were mostly white, about two-thirds male, and two-thirds of the group had attended at least some college. Most felt they were still in good health, despite their average pack-a-day habit.
All of the employees were given information about available smoking-cessation programs in their areas. Members of the financial incentive group were also told they would be given $100 for the completion of a smoking cessation program. Then, they would receive an additional $250 if they successfully quit smoking within six months from the start of the study, and they were promised another $400 if they stayed smoke-free for another six months. Smoke-free status was assessed using either a hair or urine sample to test for a substance known as cotinine, which is present when someone has smoked.
Nine to 12 months after the study began, 14.7 percent of the incentive group had kicked tobacco, compared to just 5 percent in the information-only group. Between 15 and 18 months after the study’s start, 9.4 percent of those in the incentive group had stayed off cigarettes, compared to just 3.6 percent in the control group.
Volpp said he believe the financial incentives prodded more people to quit and stay off cigarettes because they provided positive feedback as well as immediate gratification.
“I think, in general, people have a lot of trouble making changes for the sake of delayed health benefits,” he said.
“This study shows the power that a monetary incentive can offer, and the power of the workplace as a health promotion tool,” Glynn said.
For employers, Volpp pointed out that it’s often cost-effective to offer a financial incentive for employees to stop smoking. Quitting boosts productivity and decreases absenteeism and health-care costs, he said.
Glynn acknowledged that quitting smoking is very difficult, but smokers should know it’s not impossible. “There are 47 million former smokers out there — it’s not rare for people to quit smoking. But, it is a process. It’s usually not a single act, and most people do it over a year or two.”
Another study, this one published in the March issue of the American Journal of Preventive Medicine, found that cash incentives might inspire other healthy habits.
A team of researchers from RTI International in North Carolina asked 501 sedentary adults over the age of 50 what sorts of walking programs and incentives might prompt them to lace up their sneakers and start moving.
Simply by adding a theoretical offer of $9 a week, the researchers increased possible participation in a walking regimen by 31 percent.
“A number of exercise programs are structured around group activity,” study author Derek Brown said in a statement. “This was not preferred by most. We did find, though, that money would increase participation.”
Learn more about quitting smoking at SmokeFree.gov.
SOURCES: Kevin Volpp, M.D., Ph.D., staff physician, Philadelphia VA Medical Center, and director, Center for Health Incentives, Leonard Davis Institute of Health Economics, and associate professor, University of Pennsylvania School of Medicine and the Wharton School, Philadelphia; Thomas J. Glynn, Ph.D., director, cancer science and trends, and director, international cancer control, American Cancer Society, Washington, D.C.; Feb. 12, 2009, New England Journal of Medicine; March 2009, American Journal of Preventive Medicine
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