Although the smoking rate among U.S. adults has been on the decline in recent years, tobacco is still the biggest public health threat in the country, contributing to tens of thousands of preventable deaths and racking up billions in health care expenditures each year. So researchers are still trying to figure out what could convince the estimated 40 million smokers in the U.S. to kick the habit for good. Is there a more creative way to tackle the problem?
That was the subject of an innovative study that tracked a group of CVS employees who were recruited to participate in an incentive-based cessation program. According to the researchers, who published their results in the New England Journal of Medicine this week, offering smokers varying financial rewards and penalties in exchange for cutting out cigarettes worked better than they expected.
Participants were recruited through CVS and randomly assigned to several different groups that offered different kinds of rewards for quitting. They could choose whether or not they wanted to join their assigned group or drop out of the study.
The control group offered standard counseling with free smoking cessation tools, like nicorette gum. The other groups were divided between “deposit” and “reward” strategies. In the “deposit program,” smokers were required to fork over $150. If they successfully quit, they got their deposit back as well as a $650 bonus; if they didn’t quit, they lost their $150 for good. In the “reward program,” meanwhile, smokers weren’t required to make an initial deposit and simply received a $800 reward for quitting.
Smokers were significantly less likely to consent to participate in the deposit program; about 14 percent of people agreed to join it, compared to 90 percent of people who agreed to try for the $800 reward. However, the people who did agree to pay out the $150 deposit upfront were much more successful at quitting.
“People don’t want to part with their money,” Dr. Scott Halpern, a researcher at the University of Pennsylvania Perelman School of Medicine who led the study, explained to NBC News. “Among those who would have accepted either program, the deposit-based programs were twice as effective as the rewards-based programs and five times more effective than the standard of care which was provision of free access to behavior modification therapy and nicotine replacement therapy.”
It’s really hard to convince people to stop smoking. Even in the context of Halpern’s innovative financial experiments, most people weren’t able to successfully quit. More than 80 percent of smokers in the largest rewards-based group had not given up cigarettes by the end of the study.
Still, the researchers say their findings are significant because their financial incentives returned such dramatically better results than the traditional smoking cessation programs that rely on patches and gum — something they say big employers should seriously think about as they’re grappling with rising health costs.
“When you compare the fact that employers spend approximately $4,000 to $6,000 more per year to employ a smoker than to employ a non-smoker, then an incentive program that pays $800 only to those who succeed in quitting is obviously a win-win situation,” Halpern told NBC News. “It’s cost-saving for the employer and it’s health-promoting for the employee.”
The results are especially pertinent as more large companies are attempting to implement wellness programs to nudge their workers toward healthier decisions — like exercising more, eating healthier, and quitting smoking. Obamacare now provides more incentives for employers to pursue these types of preventative health efforts, helping wellness programs swell to a $6 billion dollar industry. Despite their growing popularity, however, it’s still unclear whether these programs are actually effective at changing Americans’ behavior.
Halpern says that his study offers a new path forward in this area. Instead of investing so much in wellness programs that rely on traditional smoking cessation tools like gum, companies could actually end up saving a lot of money in the long run by doling out around $800 to try to encourage their works to quit.
CVS Health, for one, isn’t wasting any time. The company, which helped fund the study, is already designing a new cessation program that will require its workers to put down a $50 deposit. If they’re still not smoking a year later, they’ll get their $50 back as well as an additional $700 bonus.
CVS has strategically positioned itself as a leader in the field of public health. Last year, the pharmacy chain announced that it would phase out the sale of all tobacco products at its stores. The move didn’t hurt the company’s revenue because the cigarette losses were offset by rising pharmacy profits.
While other pharmacies didn’t follow suit and drop cigarettes from their own shelves, it will probably be easier to push CVS’ competitors toward more effective smoking cessation programs that are better for their bottom lines. “With respect to public policy, deposit programs, which enlist loss aversion, are the better way to help people to quit smoking (and perhaps to alter many kinds of health-related behavior),” an editorial accompanying Halpern’s new study concludes.