Rewards and financial incentives successfully help people to give up smoking

Offering rewards helps people to stop smoking, with success rates continuing long after incentives have stopped. 

The new research, led by the University of East Anglia, also explored whether incentives were effective in helping pregnant women to give up smoking. 

While previous research found rewards played a moderate role in encouraging pregnant women to quit smoking, this up-to-date study found there is now “high certainty evidence” that such schemes are successful in this cohort. 

Lead author Prof Caitlin Notley, of UEA’s Norwich Medical School, said: “Smoking is the leading preventable cause of ill health and early death worldwide and quitting smoking is vitally important to help people live in good health for longer. 

“We wanted to find out if giving people rewards helps them to quit smoking in the long term. 

“We are now very confident that incentives help people, and pregnant people, to quit smoking better than not offering incentives. 

“The evidence also demonstrates that the effectiveness of incentives lasts even after rewards have stopped.” 

Incentives, such as money, vouchers or deposits, can be used to encourage people to quit smoking, and to reward them if they remain smoke-free.  

Such schemes can be run in workplaces, in clinics, and sometimes as community programmes. 

The researchers found 48 studies, which had recruited more than 21,900 participants, that tested different reward schemes to help people who smoke to quit.  

Rewards were cash payments, vouchers, or the return of money deposited by those taking part. 

Taking out the lowest-quality trials from the analysis did not change the results, which found that people receiving rewards were more likely to have stopped smoking than those in the control groups six months or more after the beginning of the trial (39 studies, 18,303 people). 

For every 100 people who received financial incentives,10 people were likely to successfully quit smoking at six months or longer, compared to seven in 100 people who did not receive financial incentives. Success rates continued beyond when the incentives had ended. 

Women who were pregnant and received rewards were much more likely to stop smoking than those in the control groups, both at the end of the pregnancy and after the birth of the baby (13 studies, 3,942 people).  

For every 100 pregnant women who received financial incentives, 13 of those were likely to successfully quit smoking at six months or longer, compared to six in 100 who did not receive financial incentives. 

Studies varied in the total amounts of rewards that were paid and there was no noticeable difference between trials paying smaller amounts (fewer than 100 US dollars) compared to those paying larger amounts (more than 700 US dollars).  

However, the researchers noted that is hard to make a fair comparison in this situation because money has different levels of importance in different cultures, and the studies they looked at came from many different countries. This made it difficult to compare results directly across the studies. 

Professor Linda Bauld, Director of the SPECTRUM Research Consortium, Co-Chair of the Smoking in Pregnancy Challenge Group and study co-author, said: “Smoking during pregnancy is one of the leading causes of poor birth outcomes including stillbirth and miscarriage.  

“These findings show that financial incentives during pregnancy can more than double the chances of quitting smoking and that incentives are also effective for preventing women from relapsing to smoking postnatally.  

“This evidence supports the case for continued investment in the existing national financial incentive scheme for pregnant women in England.” 

Co-author Jamie Hartmann-Boyce, assistant professor of health policy and promotion in the School of Public Health and Health Sciences at the University of Massachusetts Amherst, said: “People are more cautious in pregnancy about using a lot of the pharmacological interventions that are approved for smoking cessation.  

“So that’s why we’re focused on ways that we can help pregnant people quit smoking. 

“There’s a lot of evidence to suggest that this intervention is acting on the psychological reward systems in the brain, which we know are heavily involved with nicotine addiction.  

“So, it’s not that these people could have quit anyway and then were paid and decided to do so. A lot of people in these studies have tried to quit many times, they really want to quit and weren’t able to do so, and this helped them.” 

Current and future research might more precisely explore differences between trials offering low or high cash incentives and self-incentives (deposits), within a variety of smoking populations, focusing on low- and middle-income countries where the burden of tobacco use remains high. 

The research was led by UEA in collaboration with the University of Oxford, University of Edinburgh and the University of Massachusetts Amherst. 

“Incentives for smoking cessation” is published in Cochrane Review.