Cash Reward Helps Smokers Quit Bad Habit

By Margarita Nahapetyan

Smokers who are paid to quit are about three times more likely to give up a bad habit and not have another cigarette than those who get no cash reward, a new study reports.

Smoking is one of the nation's biggest causes of premature death, which is believed to kill about half a million Americans every year. About 20 per cent of all adults in the United States smoke, compared with nearly 25 per cent 10 years ago. Although most smokers reported their intention to quit, few recent researches indicated that just less than 3 per cent of those, trying every year, succeeded in doing so permanently. Getting one person to stop smoking can save businesses about $3,400 a year by boosting productivity, decreasing absenteeism and reducing diseases, according to estimates from the Centers for Disease Control and Prevention, which helped fund the study.

University of Pennsylvania enrolled 878 employees of General Electric Co. employees from around the country for a year and a half smoking-cessation program. All the participants, who smoked an average of 1 pack of cigarettes per day, were assigned randomly to one of two groups: 442 employees in one group received information about the benefits of quitting, and 436 employees in the second group were told they would receive $750 in cash in addition to participation in educational programs. The money was distributed as follows: $100 for completing an educational session, $250 for quitting smoking within six months after enrolling in the study, and $400 for continuing to abstain from smoking for an additional six months.

"People are drawn to tangible things," says a lead researcher of the study Kevin Volpp, a doctor at the Philadelphia VA Medical Center and director of the Center for Health Incentives at the University of Pennsylvania. "It makes it easier for you to do in the short term what you know is in your long-term best interest."

Three months after the enrollment in the program, all the participants were contacted and those who said they had quit smoking at any point during the study were asked to submit saliva or urine samples for biochemical testing so that their claims could be verified.

To the big surprise of researchers, the study found that after 12 months 14.7 per cent of people in the cash incentive group had quit smoking compared to 5 per cent of the participants who only received information about smoking-cessation programs without any cash reward. And after another six months, it was found that 9.4 per cent of the people in the cash incentive group were still abstaining from smoking compared to 3.6 per cent from the non cash incentive group.

Robert Galvin, chief medical officer for Fairfield, Connecticut-based General Electric Co., said that the company participated in the study in order to determine if incentives would encourage people to cease smoking, which would lower health-care costs. With every smoker trying to quit and shocked by the results of the study, General Electrics now wants to bring out a broader incentive program in 2010 for its employees all over the world. GE anyway spends about $50 million each year on health care for its smokers, a figure that does not include the cost of lost productivity, so they feel the program will start paying for itself. General Electrics is the biggest maker of jet engines and the owner of the NBC-Universal media unit, and employs about 152,000 people in the United States.

"We are very excited about the fact that we have proved that incentives can work to help stop smoking," said Galvin, who is also part of the study's research team.

Kevin Volpp called the study the largest ever of employer incentives to quit smoking. Several past studies were not able to find higher quit rates linked to financial bonuses, but he assumed maybe those included not much people or the financial incentives were too tiny, some as low as $10.

"There is something very powerful about the awards being paid to you using other people's money. That is very motivating," Volpp said. Providing people with money gives them a reward in the present rather than waiting for a future reward like better health, he said.

Dr. Volpp acknowledged that his group's research has limits and that there is a lot of more to be investigated in the future. The vast majority of study participants were similar demographically - relatively well-educated, white and with higher salaries. He said that raises questions about how such programs would work with other groups of smokers.

The study, one of the largest of its kind, came at a right time, when many institutions started paying their employees in order to do everything for their well-being, starting with losing weight to improve their grades. The latest findings were published in this week's New England Journal of Medicine.