More smokers butt out when paid: study

Employees who are paid to quit smoking may be more successful, say researchers who offered up to $750 US for anyone who butted out for a year.

In an experiment at General Electric Co., 15 per cent of study participants were tobacco-free about a year later — three times the success rate of a comparison group who weren't paid to quit smoking cigarettes, researchers report in Thursday's New England Journal of Medicine. 

'You'd be surprised at what that little incentive does.' — Dan Anzalone

"This kind of reward system provides them with direct, positive feedback in the present," rather than delayed, intangible health benefits, said Dr. Kevin Volpp of the University of Pennsylvania School of Medicine, and lead researcher of the study.

Previous studies did not find that money helped people not to fall off the wagon, but Volpp said the earlier work included too few participants or too small a financial incentive.

"You'd be surprised at what that little incentive does," said Dan Anzalone, 54, who quit smoking cold turkey three years ago next month after a 35-year habit.

Although 70 per cent of smokers in the United States say they want to quit, only about two or three per cent per year actually do, the researchers said.

Anzalone was among the 878 employees who were randomly assigned to receive information about smoking-cessation programs, and use the company's health plan for doctor visits and quit-smoking aids, or information plus financial incentives.

The bonus was:

• $100 US for completing a quit smoking program.
• $250 US for quitting within six months after enrolling in the study, as confirmed by a saliva or urine test.
• $400 US for abstaining for another six months, also confirmed in tests.

Participants were grouped by where they worked, how heavily they smoked and income.

For Anzalone, a logistics specialist at a GE plan in Schenectady, N.Y., the incentive was all it took to quit. He didn't go to smoking cessation classes or use nicotine patches, gum or medicine, even though he had repeatedly tried to quit previously.

In the study, after nine to 12 months, about 15 per cent of those who were paid had successfully quit, compared to five per cent in the unpaid group.

About four times as many people in the bonus group completed the smoking cessation program.

And about equal numbers of people in both groups used smoking cessation aids such as patches and the drug Zyban, which reduces irritability and depression, Volpp said.

The practice of paying people to quit smoking is controversial, said Dr. Norman Edelman, chief medical officer of the American Lung Association.

Edelman said a 15 per cent quit rate is pretty good, and he applauded the design of the study, which allowed participants to decided what classes to attend or products to use, compared with drug companies studies of anti-smoking products that are tightly controlled and unrealistic.

On Wednesday, GE's chief medical officer, Dr. Robert Galvin said that the company will offer a quit incentive program for its 152,000 employees starting next January. The company expects to recoup the costs of the smoking cessation program in three to five years.

It's not clear how much an insurance company or employer should be willing to pay to get an employee to quit smoking cigarettes, or if such programs would work among other groups, such as those who are less educated. 

Financial incentives have also been tested for weight loss.