Loss aversion most effective incentive for smoking cessation, but rewards yield more participation

Deposit-based monetary incentives may have higher success rates for smoking cessation, but rewards-based monetary incentives may yield more patient participation, according to a new study.

The randomized, controlled trial split 2,538 smokers, all of whom worked at CVS Caremark or were relatives and friends of those who did, into 5 groups: usual care, individual reward, collaborative reward, individual deposit, and competitive deposit. All participants were offered usual care, such as smoking cessation resources. Deposit participants paid $150 at the start of the trial before receiving bonuses for quit milestones and, if they abstained for 6 months, their initial deposit back. The reward participants received payouts of varying amounts for each milestone before earning a $200 bonus if they made it the full 6 months.

The collaborative reward arm increased individual payments based on the success of 5 other smokers (accessible through a Web chat), while the competitive deposit arm had smokers compete anonymously within their group for payments. The study, which was funded by the National Institutes of Health and CVS Caremark, was published in the May 13 New England Journal of Medicine.

The trial found no significant difference between the individual and group cessation arms but found that participants were more likely to enroll in a reward-based program than a deposit-based one (90% acceptance versus 13.9%). Ultimately, the deposit groups were most successful: 52.3% stayed smoke-free through 6 months, versus 17.1% who were rewarded and 6% who received usual care. Among the 13.7% of smokers who would accept either type of incentive program, the abstinence rate at 6 months was 13.2 percentage points higher in the deposit groups than in the reward groups. Although the deposit groups had better results, the study suggests rewards for smoking cessation are more effective overall because of their higher acceptance rate, the study authors concluded.

The implications of this study lie in research and public policy, according to an accompanying editorial. Regarding public policy, deposit programs that employ loss aversion are a better way to help people quit smoking, but the catch is getting people involved. Future research could examine whether a smaller deposit increases participation without sacrificing efficacy. “The challenge is to find a way to nudge people to enroll in such programs,” the editorialist wrote. “If that challenge cannot be met, reward programs are much better bets.”