Active referral plus a small financial incentive upon cessation services use on smoking abstinence: a community-based, cluster-randomised controlled trial

Abstract

Background: Many smokers do not use existing free or low-cost smoking cessation services, cost-effective interventions to increase use are needed. Methods:We did a 2-armed cluster randomised controlled trial (cRCT) in Hong Kong, China, to evaluate the effectiveness of active referral plus a small financial incentive on abstinence. Chinese adult smokers who smoked at least 1 cigarette per day were proactively recruited from 70 community sites (clusters). Random allocation was concealed until the recruitment started. The intervention group received an offer of active referral to cessation services at baseline plus an incentive (HK$300/US$38) after using any cessation services within 3 months. The control group received general brief cessation advice. The primary outcomes were biochemically validated abstinence at 3 and 6 months. Operating costs in real-world implementation was calculated. Trial Registry: ClinicalTrials.gov NCT03565796 .Findings: Between June and September 2018, 1093 participants were randomly assigned to the intervention (n = 563) and control (n = 530) groups. By intention-to-treat, the intervention group showed higher validated abstinence than the control group at 3 months (8.4% vs. 4.5%, risk ratio [RR] 1.88, 95% CI 1.01-3.51, P = 0.046) and 6 months (7.5% vs. 4.5%, RR 1.72, 95% CI 1.01-2.93, P = 0.046). Average cost per validated abstinence was lower in the intervention (US$ 421) than control (US$ 548) group.Interpretation: This cRCT has first shown that a simple, brief, and low-cost intervention with active referral plus a small monetary incentive was effective in increasing smoking abstinence and smoking cessation service use in community smokers.

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“…This is unavoidable, given the use of proactive outreach strategies to approach hard‐to‐reach smokers in companies and the low smoking prevalence in Hong Kong [8]. Our previous trials also found a large proportion of unmotivated smokers in emergency departments (71.0%) [30] and communities (69.5%) [31]. Company‐level workplace support might help to increase motivation to quit smoking [32].…”

“…Our previous trials also found a large proportion of unmotivated smokers in emergency departments (71.0%) [30] and communities (69.5%) [31]. Company-level workplace support might help to increase motivation to quit smoking [32]. We have previously reported that some companies (15%) were not compliant with the smoke-free workplace ordinance in Hong Kong [9].…”

High Perceived Susceptibility to and Severity of COVID-19 in Smokers Are Associated with Quitting-Related Behaviors

“…Those who successfully quit during the contest with biochemical validation were awarded up to HK$1000 (≈US$125). The main results of the contest in 2018 are reported elsewhere [24].…”

Smoking Cessation Programs Are Less Effective in Smokers with Low Socioeconomic Status Even When Financial Incentives for Quitting Smoking Are Offered—A Community-Randomized Smoking Cessation Trial in Denmark

“…Our study also found that neither the FIMs nor the CAMs succeeded in attracting more smokers with low SES during the intervention year than the year before. Previous studies indicated that financial incentives can be a good recruitment method to smoking cessation activities [ 43 , 44 ], even for disadvantaged smokers [ 39 ]. Evidence on interventions that are successful in attracting smokers with low SES to smoking cessation services is needed.…”