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Journal Club 3 June 2015


Randomized Trial of Four Financial- Incentive Programs for Smoking Cessation




Financial incentives promote many health behaviors, but effective ways to deliver
health incentives remain uncertain.


We randomly assigned CVS Caremark employees and their relatives and friends to
one of four incentive programs or to usual care for smoking cessation. Two of the
incentive programs targeted individuals, and two targeted groups of six participants.
One of the individual-oriented programs and one of the group-oriented
programs entailed rewards of approximately $800 for smoking cessation; the others
entailed refundable deposits of $150 plus $650 in reward payments for successful
participants. Usual care included informational resources and free smokingcessation


Overall, 2538 participants were enrolled. Of those assigned to reward-based programs,
90.0% accepted the assignment, as compared with 13.7% of those assigned
to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained
abstinence from smoking through 6 months were higher with each of the
four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05
for all comparisons); the superiority of reward-based programs was sustained
through 12 months. Group-oriented and individual-oriented programs were associated
with similar 6-month abstinence rates (13.7% and 12.1%, respectively;
P = 0.29). Reward-based programs were associated with higher abstinence rates
than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-
variable analyses that accounted for differential acceptance, the rate of abstinence
at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to
22.8) higher in the deposit-based programs than in the reward-based programs
among the estimated 13.7% of the participants who would accept participation in
either type of program.


Reward-based programs were much more commonly accepted than deposit-based
programs, leading to higher rates of sustained abstinence from smoking. Grouporiented
incentive programs were no more effective than individual-oriented

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