SOURCES: Scott Halpern, M.D., Ph.D., assistant professor, medicine, epidemiology, medical ethics, health policy, Perelman School of Medicine, University of Pennsylvania, Philadephia, Pa.; Cass Sunstein, J.D., professor, Harvard University Law School, Cambridge, Mass.;May 13, 2015, New England Journal of Medicine, online
WEDNESDAY, May 13, 2015 (HealthDay News) -- Paying smokers to quit seems to work better than offering them free counseling and nicotine replacement therapy, new research suggests.
"Roughly 18 percent of Americans smoke regularly -- a percentage that hasn't changed in more than a decade despite the proliferation of new therapies. We desperately need new interventions, and this study shows that financial incentives are likely as good, if not better, than other available interventions," said lead author Dr. Scott Halpern, an assistant professor of medicine, epidemiology, medical ethics and health policy at the Perelman School of Medicine at the University of Pennsylvania.
In the study of more than 2,500 CVS Health employees across the United States, some smokers were rewarded money if they quit, while others could earn back more than their $150 deposit if they quit. However, those who put up their deposit could also lose it if they weren't successful with quitting. Although fewer people opted for putting their own money at risk, those who did were more likely to quit than those who chose the reward challenge.
"We found that reward-based programs were more effective overall because many people didn't want to sign up for the programs requiring deposits," Halpern said.
However, for the approximately 14 percent of smokers who would have accepted any program, the deposit programs were twice as effective as the rewards programs, and five times more effective than simply receiving free smoking aids, he said.
People in reward-based programs could get $800 if they quit, and those in deposit-based programs could get back their $150 deposit plus $650 if they quit, the researchers explained.
Employers and insurers could do a lot more to curb smoking and to reduce costs by designing programs that account for human psychology, Halpern noted. "That people seek to minimize loss is one of several psychological insights that can help supercharge incentive programs without increasing their costs to employers or insurers," he said.
The report was published online May 13 in the New England Journal of Medicine.
Cass Sunstein, a professor at Harvard University Law School and author of an accompanying editorial, said "nudges" can help to reduce smoking.
"Nudges are approaches that maintain people's freedom but help them to get where they want to go -- a lot like a GPS," he said. "For smoking, voluntary cessation programs can have a big effect, if they are well-designed."
If people voluntarily enter a program in which they can lose money if they fail to quit smoking, the program is likely to be effective, Sunstein said. "People do not like losses -- and when their own money is at risk, they are more likely to quit," he said.
People, however, are less likely to enroll in a program in which they stand to lose money if they don't quit, he said. "Those programs are more effective for those who enroll in them -- but less attractive to those who are deciding whether to enroll," Sunstein said.
"If you want people to enroll in a smoking cessation program, you'll do better if you offer them a reward, and don't ask them to put their own money at risk. Those programs work, too, but less well," he said.
Visit the American Cancer Society for tips on how to quit smoking.