Can incentives help employees quit smoking?

Can incentives help employees quit smoking?

Financial incentives can increase smoking cessation in diverse populations, with evidence showing moderate effects. However, the quality of this evid

Financial incentives can increase smoking cessation in diverse populations, with evidence showing moderate effects.
However, the quality of this evidence is low because of inadequate randomisation and allocation procedures, deficient outcome reporting, and confounding.

Furthermore, the effectiveness of incentives is difficult to determine because of a wide range in type and size of the incentives. Additionally, previous studies were mainly done in the USA, which might limit generalisability. Finally, most studies have solely investigated the effect of incentives, without accompanying group counselling for smoking cessation. The effect of the combination of incentives with counselling is especially important to assess, considering evidence that group counselling can effectively enhance quit success.

Previous studies provided an indication of which aspects of incentive-based programmes are effective. A study
comparing different incentive schemes showed that reward-based incentive programmes (ie, smokers receive a reward) can possibly be more effective than deposit-based programmes (ie, smokers receive a refund of their own money deposit) in increasing smoking cessation, because of relatively high acceptance of reward-based incentive programmes. Additionally, group counselling is more effective than self-help or less intensive help, such as brief support from a health-care provider.

Although incentives for smoking cessation have been studied in different ways, these studies show modest quit rates at best. Although previous studies have shown evidence that reward-based incentives, group counselling, and workplace-situated interventions are effective, no study has effectively combined these elements. The aim of the new study was to examine the effectiveness of a combination of these effective components within a cluster-randomised trial.

“We hypothesised that incentives in combination with a group smoking cessation training programme organised at the workplace would increase quit rates compared with a group training programme alone. A second aim was to investigate whether incentives might result in different cessation rates for employees with different levels of education, income, or nicotine dependency.

“We approached companies of varying size and from different industry types in the Netherlands to participate in this study by email and phone. Companies were required to facilitate a smoking cessation training programme at the workplace during or directly after working hours. Employees within participating companies were recruited by the company management using flyers, posters, email, and intranet messages, and spouses could also participate. Participants needed to be current tobacco smokers aged at least 18 years. Exclusion criteria were an acute life-threatening disease, not being a currently active smoker, not being able to read or speak Dutch, and having already started an attempt to quit smoking at the moment of inclusion. Before the start of the study, all participants were informed about the design of the study and the possibility to receive vouchers for quit success. All participants gave written informed consent.”

The results

For the primary outcome at 12 months, 131 (41%) of 319 participants in the intervention group and 75 (26%) of 284 participants in the control group were verified quitters. Incentives significantly increased 12-month continuous abstinence, with validated quit percentages of 41% in the intervention group with 26% in the control group. The study used much smaller incentives than other studies – $100 – which suggests that modest incentives might have the potential to be as effective as large incentives if combined with additional smoking cessation support.


“This study showed that modest incentives can elicit substantial quit success. The results of the current study might therefore motivate employers to facilitate a smoking cessation programme combined with incentives at the workplace to help employees to quit smoking.”