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Want Me to Quit Smoking? Pay Me

Here’s a new way to get people to quit smoking – pay them.
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Here’s a new way to get people to quit smoking: pay them. A pilot program that tried this rewards-based approach worked unexpectedly well, researchers reported Wednesday.

Offering such a reward may work especially well for employers who dish out thousands of dollars a year more in health insurance payouts to smokers than they spend on non-smokers, the researchers said.

And it may pay to tailor the incentive. They found that a select group of people who agreed to put down a $150 “bet” that they could kick the habit were very motivated to quit. After a year, more than half of them were still not smoking, the researchers report in the New England Journal of Medicine.

“People don't want to part with their money,” said Dr. Scott Halpern of the University of Pennsylvania Perelman School of Medicine.

“People don't want to part with their money."

Halpern’s team ran a pilot program, signing up 2,538 people from across the United States in 2012. They were assigned to one of five groups, each with a different incentive:

  • An $800 reward for quitting as an individual;
  • A reward for quitting as a group of six;
  • Putting down an upfront deposit of $150 that would be doubled and returned if the smoker quit;
  • A competitive deposit (competing for other participants' deposits and matching funds);
  • Or the usual counseling with free smoking cessation aids such as nicotine gum

Almost everyone agreed to stay in the reward program, but just 14 percent of those assigned to the deposit groups stuck it out.

Only 6 percent of those who got counseling and stop-smoking aids were able to quit. But 12 to 14 percent of those in the rewards groups were able to quit for six months or more.

“We found that those programs that first required people to deposit $150 of their own money were less acceptable to people than programs that were pure rewards,” Halpern said.

“However, 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 pays off either way. With 18 percent of Americans still smoking, doctors and employers alike are desperate for creative new ways to help people stop.

“It's cost-saving for the employer and it's health-promoting for the employee.”

“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 rewards approach works well with weight loss, and now groups all over the country compete to see whose team can lose the most weight.

“Right now, more than 80 percent of employers are spending on average $700 a year per employee with incentive-based wellness programs,” Halpern said.

“But my sense is that most of those programs are relatively blind to human psychology. They don't account for the fact that a dollar is not necessarily a dollar. And what is perhaps as important if not more important than the number of dollars you give is the ways in which you give those dollars.”

In other words, it’s worth trying to work in a little bit of a stick alongside the carrots.

CVS Health, which helped sponsor the trial, is putting it to real-life use. The company is preparing a campaign called "700 Good Reasons," in which all employees who smoke will be able to deposit $50, and if they test negative for tobacco 12 months later, they will get back their $50 back plus $700 more.