Financial incentives are found to be three times more effective than e-cigarettes and other stop-smoking aids, in a University of Pennsylvania Perelman School of Medicine-led study.

“Smoking remains the leading cause of preventable deaths in the United States, and nearly all large employers offer wellness programs aimed at getting people to quit,” said lead author Scott D. Halpern, from the University of Pennsylvania Perelman School of Medicine.

“But, these programs vary considerably, and to date, there has been little evidence to suggest which designs and strategies are most effective.”

“The new study drives forward previous research by showing that even among smokers who are not cherry picked on the basis of their motivation to quit, financial incentives still triple quit rates, whereas offering free conventional cessation aids or free e-cigarettes accomplishes nothing at all.”

The study enrolled 6,006 participants from across 54 U.S.-based companies. Participants were assigned to one of four smoking cessation intervention groups or usual care.

Smoking cessation interventions included usual care plus one of the following:

(i) free e-cigarettes, in flavors of participants’ choosing;

(ii) free cessation aids (nicotine patches, gum, and other medications, with free e-cigarettes only available for participants who’ve tried standard therapies previously);

(iii) free cessation aids plus $600 in rewards for sustained abstinence from smoking;

(iv) free cessation aids plus $600 in redeemable funds, which were deposited in an account for each participant and removed if smoking cessation milestones were not met.

The study found that overall, only 1.3% of participants remained smoke-free for at least six months.

However, the quit rates for redeemable deposits were significantly higher than with free cessation aids or with free e-cigarettes, and the quit rate for the rewards group was also higher than for cessation aids.

By contrast, no differences were found in the quit rates among participants assigned to free e-cigarettes, free cessation aids, or usual care.

Of the more than 6,000 participants enrolled in the trial, 1,191 actively engaged with their assigned program.

Those engaged in the trial were more motivated to quit, making them similar to smokers enrolled in prior studies that only enrolled participants who expressed an active interest in quitting.

These motivated smokers were four to six times more likely to stay smoke-free for six months after the target quit date compared to those who did not actively engage.

“The quit rates observed among these engaged participants are consistent with those found in prior studies of incentives among motivated smokers,” the researchers said.

“However, in the new study, even among these engaged participants, neither free e-cigarettes nor free cessation aids produced higher quit rates than usual care.”

“Knowing that offering free e-cigarettes does not help smokers quit should inform the policies being deliberated at the FDA regarding whether or how to regulate e-cigarettes. The result is concerning because it suggests that e-cigarettes may do more harm than good,” Dr. Halpern said.

“One of the key virtues of incentive programs is that they only cost money if people succeed in changing their behavior,” said study senior author Dr. Kevin Volpp, also from the University of Pennsylvania Perelman School of Medicine.

“By contrast, employers that offer free cessation aids to their employees are paying money whether or not the aids help the smokers quit.”

The study was published online in the New England Journal of Medicine.

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Scott D. Halpern et al. A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation. New England Journal of Medicine, published online May 23, 2018; doi: 10.1056/NEJMsa1715757