How Financial Incentives Increase Smoking Cessation: A Two-Level Path Analysis

Abstract

Introduction Financial incentives effectively increase smoking cessation rates, but it is unclear via which psychological mechanisms incentives influence quit behavior. The current study examines how receiving financial incentives for smoking cessation leads to quitting smoking and investigates several mediators and moderators of that relationship. Aims and Methods The study sample consisted of 604 tobacco-smoking employees from 61 companies in the Netherlands who completed a baseline and follow-up questionnaire. The current study is a secondary analysis from a cluster randomized trial where employees received smoking cessation group counseling at the workplace. Participants in the intervention group additionally received financial incentives of €350 in total for 12-month continuous smoking abstinence. We used a two-level path analysis to test a model that assesses the effects of financial incentives through smoking cessation program evaluation, medication use, nicotine replacement use, attitudes, self-efficacy, and social influences on quit success. We additionally tested whether an individual’s reward responsiveness moderated the influence of incentives on quit success. Results The effect of financial incentives on quit success was mediated by a higher self-efficacy. Financial incentives were also associated with a higher use of cessation medication. A more positive program evaluation was related to higher self-efficacy, more social influence to quit, and more positive attitudes about quitting. The results did not differ significantly by individual reward responsiveness. Conclusions The results of the current study suggest that financial incentives may be used to increase medication use and self-efficacy for quitting smoking, which offers an indirect way to increase successful smoking cessation. Implications (1) This is the first study investigating via which psychological pathways financial incentives for quitting smoking can lead to long-term quit success. (2) The results showed a path between financial incentives and a higher likelihood of medication use. Incentives may encourage smokers to use medication in order to increase their chance of quitting smoking and receive the reward. (3) There was a path from financial incentives to quit success via a higher self-efficacy. (4) The effects of financial incentives did not depend on individual reward responsiveness.

Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial

“…One study found that the effect of telemedicine for smoking cessation on cessation was mediated by providers’ support, which, in turn, led to increased self-efficacy and impacted cessation [ 28 ]. Another study found that the effect of financial incentives on quitting smoking was mediated only by self-efficacy but not program satisfaction [ 30 ]. The unique value of the current study’s serial mediation model is in demonstrating how treatment engagement leads to higher cessation outcomes [ 7 , 24 , 25 ].…”

“…These results will provide the first known evidence on potential serial mediators of smartphone apps for smoking cessation. While such serial mediational models are useful for developing an in-depth understanding of intervention efficacy, they are rare in smoking cessation research [ 28 - 30 ].…”

How and why do financial incentives contribute to helping people stop smoking? A realist review protocol

“…Other studies have found that the use of financial incentives can be complementary to other stop smoking interventions. A secondary analysis of a cluster randomised trial (n=604) in the Netherlands, for example, found that financial incentives can influence smoking cessation in indirect ways by increasing self-efficacy and medication use, suggesting that incentive-based interventions may best be combined with other smoking cessation methods 25. Moreover, the authors reported an association between positive programme evaluations and a number of psychosocial factors, including ‘higher self-efficacy, more social influence to quit and more positive attitudes about quitting’ 25…”

“…Moreover, incentive-based interventions can have mixed results in different populations and implementation ‘may not be transferable from one country to another’ due to differing cultural norms and attitudes towards the use of monetary rewards to change health behaviours 16. Notably, at least one study has reported that the effect of financial incentives did not depend on an individual’s responsiveness to rewards 25…”

Feasibility, tolerability, and potential advantages of a dyadic financial incentive treatment for smoking cessation among dual-smoker couples: A pilot study.

“…People who received FITs for smoking cessation (vs. nonincentive group) were more likely to have higher rates of smoking cessation program enrollment (Hennrikus et al, 2002), quit attempts, and abstinence (Donatelle et al, 2000;Giles et al, 2014;Halpern et al, 2018;van den Brand et al, 2021;Volpp et al, 2006Volpp et al, , 2009. FITs for continued abstinence through 1year predicted smokers' long-term quit success (van den Brand et al, 2021). Furthermore, the effectiveness of FITs for smoking cessation continues beyond the duration of incentive provision (Notley et al, 2019).…”