Heterogeneity in the Effects of Reward- and Deposit-based Financial Incentives on Smoking Cessation

Abstract

Rationale: Targeting different smoking cessation programs to smokers most likely to quit when using them could reduce the burden of lung disease.Objectives: To identify smokers most likely to quit using pure reward-based financial incentives or incentive programs requiring refundable deposits to become eligible for rewards.Methods: We conducted prespecified secondary analyses of a randomized trial in which 2,538 smokers were assigned to an $800 reward contingent on sustained abstinence from smoking, a refundable $150 deposit plus a $650 reward, or usual care.Measurements and Main Results: Using logistic regression, we identified characteristics of smokers that were most strongly associated with accepting their assigned intervention and ceasing smoking for 6 months. We assessed modification of the acceptance, efficacy, and effectiveness of reward and deposit programs by 11 prospectively selected demographic, smoking-related, and psychological factors. Predictors of sustained smoking abstinence differed among participants assigned to reward-versus deposit-based incentives. However, greater readiness to quit and less steep discounting of future rewards were consistently among the most important predictors. Deposit-based programs were uniquely effective relative to usual care among men, higher-income participants, and participants who more commonly failed to pay their bills (all interaction P values , 0.10). Relative to rewards, deposits were more effective among black persons (P = 0.022) and those who more commonly failed to pay their bills (P = 0.082). Relative to rewards, deposits were more commonly accepted by higher-income participants, men, white persons, and those who less commonly failed to pay their bills (all P , 0.05).Conclusions: Heterogeneity among smokers in their acceptance and response to different forms of incentives suggests potential benefits of targeting behavior-change interventions based on patient characteristics.Clinical trial registered with www.clinicaltrials.gov (NCT 01526265).

Participation in a workplace smoking cessation program incentivized by lowering the cost of health care coverage: Findings from the LLUH BREATHE cohort

“…Our findings in Table 2 indicating that male employees were significantly less likely to participate confirm the findings of several large meta-analyses of workplace preventive programs and workplace smoking cessation programs [3][4][5][6] . In a meta-regression of 23 worksite prevention programs, Robroek et al 5 found that women had significantly higher participation than men (OR=1.67; 95% CI: 1.25-2.27), but that this advantage was not apparent for preventive programs on physical fitness (i.e.…”

“…One factor contributing to the high participation rate in the LLUH BREATHE cohort in smoking cessation was the use of an individual 'reward-based' incentive (as opposed to 'deposit-based' incentive) -a method that has been shown in two large systematic reviews 3,5 and one large randomized controlled trial 6,7 to be very effective in accomplishing both participation and higher rates of smoking cessation 10,12 . LLUH BREATHE participants promoted smoking cessation by enrolling in the health plan that contained reduced monthly out-of-pocket contribution, prescription drug costs and co-payments -thus tangibly increasing their individual monthly income.…”

“…diet, smoking, and physical activity programs) 5 . Recently, Halpern et al 6 identified, in asecondary analysis of the large CVS Caremark trial, that men were less likely to participate in reward-based workplace smoking cessation programs. Taken together, the findings from our work and other studies highlight the need to find additional programmatic design features to engage and/or encourage male employees in workplace smoking cessation programs.…”

“…privacy concerns, employer intrusion on health) may also be needed 8,9 . Halpern et al 6 raise the possibility that deposit-based incentives perform better for workplace smoking cessation programs for men.…”

“…There is, however, wide variation in the type of incentives used and the efficacy of the incentive strategies 3,4,6 . Incentive strategies vary in workplace smoking cessation programming.…”