A study from The University of Texas Health Science Center at Houston (UTHealth) and published in the American Journal of Public Health reports that small financial incentives doubles smoking cessation rates in smokers who are part of socioeconomically disadvantaged demographics. The study was funded by the UTHealth School of Public Health and the American Cancer Society.
The CDC reports that use of tobacco products is the lead cause of preventable mortality in the US. Public health efforts have been designed to decrease smoking rates, and by and large the efforts have been effective, lowering rates 18 percent among American adults. However, data shows that almost 30 percent of those who live in poverty continue to smoke. Researchers say that smoking rates are highest in demographics that are socioeconomically disadvantaged.
Darla Kendzor, Ph.D., assistant professor in the Division of Health Promotion and Behavioral Sciences at the UTHealth School of Public Health Dallas Regional Campus explained in a press release that they wanted to understand how populations below the poverty line would react to small financial incentives to stop smoking. “We
wanted to investigate how small and potentially cost-effective financial incentives might help safety net hospital patients quit smoking,” since the researchers report that safety net hospitals do in fact provide significant care to vulnerable populations with low-income and uninsured.
The study enrolled patients from the Parkland Smoking Cessation Clinic in Dallas from 2011 to 2013. Those recruited were seriously socioeconomically disadvantaged with an average household income of less than $12,000 a year; 85 percent were not employed and more than 50 percent were uninsured. Patients were randomly assigned to usual clinic care or an intervention group. The usual clinic care included an education and orientation session, physician visits, pharmacological treatment, and support group meetings once per week. The second intervention group consisted of usual care and financial incentives for smoking abstinence (biochemically verified).
Patients that enrolled in the second approach, the intervention group, could receive “$20 in gift cards for abstinence on the quit date, and this amount increased by $5 each week for continued abstinence up to $40. Thus, participants could earn up to $150 in gift cards over four weeks. Progress was monitored for 12 weeks following the quit date,” as noted in the UTHealth press.
Among the intervention group, abstinence rates were much higher at all visits that followed the quit date. After four weeks, 49 percent of the intervention group remained abstinent versus 25 percent of the usual clinic care. After those four weeks, the financial incentives were discontinued; eight weeks after that (a total of twelve weeks since the beginning of the process) 33 percent of the intervention group remained abstinent against 14 percent of the usual care group.
During the first four weeks after the quit date, participants earned an average of $63 in gift cards for their abstinence. Since the clinic sees 200 patients per year, the estimated cost of this reward method is about $12,680. However, lung cancer treatment per person in 2010 was determined to be between $60,533 and $73,062, according to the National Cancer Institute. From this point of view, the low cost of this intervention group approach could prevent smoking-related illnesses such as respiratory diseases, cardiovascular diseases and cancer, save money ,and most importantly, foster well-being and lives.
“We found that women assigned to the financial incentives intervention had the highest cessation rates, which was surprising because women often have lower cessation rates than men participating in treatment,” according to Kendzor. Also, the researchers intend to evaluate long-term effects of this financial incentives by following participants for 6 months.