Cash rewards help smokers quit, JAMA study finds

Paying active smokers up to $600 in cash rewards to quit is twice as effective as standard healthcare advice, according to a clinical trial published in the Journal of the American Medical Association.

Researchers from the University of Pennsylvania found that offering direct financial incentives significantly boosted success rates, even among a group of long-term, heavy smokers who had spent decades struggling to kick the habit.

How the study worked

The clinical trial tracked more than 3,200 active smokers who had been referred for lung cancer screening. This is a historically hard-to-reach group, with most participants having smoked for decades and tried to quit multiple times before.

The researchers split the participants into four distinct groups to compare different quitting strategies:

• Cash incentives: Participants could earn a total of $600, paid out in stages: $100 after two weeks, $200 at three months, and $300 at six months. To collect the money, they had to pass blood or urine tests confirming they were entirely nicotine-free. They were also offered free quit-smoking medications.
• Standard care: Participants were simply referred to local community or healthcare smoking cessation resources.
• Free medication: Participants received standard care referrals and free quit-smoking drugs.
• Free medication and text support: Participants received standard care, free drugs, and access to text-based support programmes.

Cash beats medicine and texts

At the end of the six-month trial, the financial incentives clearly outperformed all other methods.

About 8% of those offered cash and free medication successfully quit smoking. In comparison, only 3% of the standard care group managed to quit.

Surprisingly, the groups offered free medication without cash performed the worst. Only 1% of those given free medication alone stopped smoking, and just 2% of those given medication alongside text-based support quit.

"These participants had smoked for decades and likely made multiple unsuccessful quit attempts in the past," Dr Scott Halpern, senior researcher and director of the Palliative and Advanced Illness Research Center at the University of Pennsylvania, said in a news release.

Halpern added that the cash incentives successfully boosted quit rates in a population that is typically very difficult to reach with standard medical approaches.

What happens next

The researchers now plan to look into how health systems might actually implement these cash-for-quitting programmes in the real world. They also want to study how the general public feels about the idea of paying people to change their health habits.

While paying patients can sometimes be a hard sell to tax-payers or insurance companies, the long-term healthcare savings from reduced lung cancer and heart disease rates could make it a highly cost-effective option.

"Finding new approaches that help people successfully stop smoking can have an enormous impact, not only on their health but also on their quality of life," said lead researcher Dr Joanna Hart, an assistant professor of pulmonary, allergy and critical care at Penn Medicine.