quit4u: the effectiveness of combining behavioural support, pharmacotherapy and financial incentives to support smoking cessation

Abstract

The 'quit4u' stop smoking service (SSS) was developed by National Health Service (NHS) Tayside for smokers in deprived areas of Dundee (UK). quit4u combined behavioural support and pharmacotherapy with financial incentives for each week that participants remained quit. A quasi-experimental study was undertaken with smokers using quit4u between 2009 and 2011 compared with smokers using SSSs in the rest of Scotland. The outcome measures were: number of quit attempts; quit rates at 1, 3 and 12 months; cost-effectiveness. Mechanisms of change were explored through quantitative and qualitative research that explored the views and experiences of service users and professionals involved in quit4u. The number of quit attempts made using SSSs in deprived areas of NHS Tayside increased by 44% between 2007 and 2010. quit4u had significantly higher quit rates at 1 month (49.9% versus 33.7%), 3 months (30.7% versus 14.2%) and 12 months (9.3% versus 6.5%) compared with similar smokers using other SSSs. The incremental cost per quitter was £2296. A combination of elements kept clients engaged and supported quit attempts: carbon monoxide (CO) tests, financial incentives, high-quality pharmacy support, rolling groups and greater varenicline use. quit4u may provide an effective and cost-effective model for engaging and supporting smokers in deprived areas to quit.

Give It Up For Baby: outcomes and factors influencing uptake of a pilot smoking cessation incentive scheme for pregnant women

“…The evaluation of a similar smoking cessation incentive scheme (Quit4U) has suggested that the weekly CO breath test provided a place from which to engage the participant in a supportive discussion [20]. A further paper evaluating this incentive scheme proposed that the smoking cessation incentive scheme might reverse the felt contractual relationship between service-provider and client with the client now the provider who is paid to quit [21].…”

“…Further challenges to the use of public money for incentive schemes have been made and little evidence exists to gauge the correct level of incentive to produce a worthwhile effect, although NICE have recommended small cash amounts for contingency management in substance misusers [22]. Some emerging evidence suggests that the beneficial effect of the incentive may be sustained beyond the period of payment: the Quit4U intervention mentioned above provided incentives for 12 weeks and the evaluation showed 46% increase in cessation at 12 months compared to the Scottish benchmark [20]. …”

Impact of specialist and primary care stop smoking support on socio‐economic inequalities in cessation in the United Kingdom: a systematic review and national equity analysis

“…The remaining four papers assessed the efficacy of innovations targeting smokers from disadvantaged areas. Three explored the impact of financial incentive schemes in Scotland: a cohort study of a pharmacy-based intervention for pregnant smokers [48] (M/L), an RCT of an SSS-administered scheme for pregnant smokers [49] (H/M) and a quasi-experimental evaluation of a programme for all residents delivered across various primary care settings [47] (H/M). Only Radley et al [48] found an improvement in quit attempts, but all three schemes demonstrated higher quit success rates than those reported across a range of other comparator interventions.…”

“…Full details of the national equity/sensitivity analyses for England and Northern Ireland are in Supporting information, Appendix S2(F). Bennett et al (2015) [41] Customized cessation advice matched to smoker's reading level plus brief endorsement letter from GP (SES tailored) Gilbert et al (2017) [42] Customized risk letter from GP plus invitation to attend a no-commitment taster session at a local stop smoking service Maskrey et al (2015) [43] Pack of relapse prevention booklets distributed through stop which aimed to help quitters recognize high-risk relapse situations and give them the skills to cope in such situations Stapleton et al (2013) [24] RCT of three forms of pharmacotherapy (NRT alone, bupropion alone, and combination NRT + bupropion) delivered through stop smoking services (SSS) Turner et al (2013) [44] Extended course of NRT for relapse prevention given to SSS clients who remained successfully quit at 4 weeks Venn et al (2016) [45] Mobile drop-in, community-based stop smoking service which sought to improve reach among disadvantaged smokers (SES tailored) Studies of interventions targeted at disadvantaged groups Kassim et al (2016) [46] Community-based outreach stop smoking service with opportunity to receive support in smoker's native language from adviser of same gender Ormston et al (2015) [47] Financial incentives scheme (quit4u) targeted at smokers living in deprived areas delivered across a range of primary care settings Radley et al (2013) [48] Financial incentives scheme (Give It Up for Baby) targeted at pregnant smokers in deprived areas delivered through community pharmacies Tappin et al (2015) [49] Financial incentives scheme targeted at pregnant smokers in deprived areas delivered through community-based stop smoking services GP = general practitioner; RCT = randomized controlled trial; NRT = nicotine replacement therapy; SES = socio-economic status.…”

Self-Incentives Uniquely Boost Cessation in Community-Based Stop Smoking Programs: Randomized Controlled Trial

“…For example, significantly more pregnant smokers quit when randomized to a financial incentive condition compared to an active control condition (22.5% and 8.6% respectively; d = 0.63, [12]). Despite these encouraging findings, there is very little evidence that financial incentives are deployed outside of randomized controlled trials [12,13], which has been attributed to cost [14] and lack of public acceptability for paying smokers to quit [p. 292, 15].…”