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 That's the lesson of a new study in the New England Journal of
Medicine that compared five smoking cessation techniques in 2,538
employees of the CVS drug store chain, along with their friends and
relatives, using a payment system in which participants could earn
roughly $800.
The study "is important because we have to figure out the most
effective and efficient ways to deliver smoking cessation
treatment," said Dr. Norman Edelman, senior scientific advisor for
the American Lung Association, who was not associated with the
research.
Compared to programs that simply offered cash for continued
abstinence, programs that required the up-front cash deposit were
twice as effective among people who agreed to make the deposit in
the first place.
"It leveraged people’s natural aversion to losing money," said lead
author Dr. Scott Halpern of the Perelman School of Medicine at the
University of Pennsylvania.
The only problem: not a lot of people were willing to buy into that
type of program. Most preferred to sign up for programs that simply
offer the cash reward if they are successful. But their failure rate
was much higher.
"The trick now is to refine the deposit programs so they'll be more
popular without losing much, if any, of their effectiveness,"
Halpern told Reuters Health.
About 18 percent of U.S. adults still smoke. But smoking cessation
programs are notoriously ineffective, which is why the American Lung
Association advises smokers that repeated attempts may be required
to get off cigarettes.
Previous research has suggested that an employee who smokes costs an
employer an extra $4,000 to $6,000 a year. Thus, many companies use
a variety of incentives, both positive and negative, to get workers
to quit.
However, "Most of these programs are blind to basic human
psychology," Halpern said. "Many are structured in a way that
employees that stop smoking are rewarded by having less money taken
out of their paychecks for insurance premiums for the next year. But
by bundling the rewards into paychecks, they're fairly invisible to
people. And the fact that they occur in the future makes them less
influential than if people were handed the same amount of money more
quickly."
To gauge which incentive programs might be most effective, all the
volunteers were offered access to stop-smoking guides and other
smoking cessation resources. Those getting health benefits from CVS
could also get nicotine-replacement therapy and a behavior
modification program.
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One group stayed with that regimen. Others formed four groups, in
which some individuals were randomly assigned to a “clan” of five
other people, and how much they earned depended on the performance
of their whole clan. Some were asked to pay $150 to participate,
which they would get back later with a $700 bonus if they remained
abstinent, while others did not have to pay up front.
Only 12.6 percent of individuals and 15.1 percent of clan members
signed up for the up-front payments. In contrast, participation
rates were 85 percent to 95 percent among volunteers who were just
promised money if they were successful and didn't have to make a
deposit.
However, their failure rate was much higher. Only 16 percent
remained smoke-free for six months while the quit rate in the
up-front payment group was 52 percent. The rate was 6 percent in the
usual-care group.
Adjusting for who accepted and who did not, "The deposit programs
were twice as effective as the reward programs and five times more
effective than providing free smoking cessation aids like nicotine
replacement therapy," Halpern said.
Edelman told Reuters Health by phone that it was "discouraging but
not unanticipated” that the successful quit rate was cut in half
after a year.
Ultimately, "my sense is that employers and insurers could do a
whole lot more to curb smoking and reduce costs to themselves by
designing their programs in a way that accounts for human
psychology," Halpern said. "The fact that people actively seek to
minimize loss is one of several psychological insights that can help
supercharge incentive programs without increasing their costs."
Based on the results, "CVS Health is rolling out a campaign called
'700 Good Reasons,'" Halpern said. "Instead of requiring a $150
deposit, it will require a $50 up-front deposit. If people are
abstinent at 6 and 12 months, they'll not only get their $50 back
but get an additional $700. Because they'll still have some skin in
the game, it should be fairly effective."
SOURCE: http://bit.ly/1rzGOHe New England Journal of Medicine,
online May 12, 2015.
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