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Low-Income Financial Incentives Make Smoking Cessation Successful

— July 5, 2024

Study finds monetary incentives can double quitting rates among economically disadvantage adults.

Published in JAMA Network Open, a new study led by Dr. Darla Kendzor, Co-Director of the TSET Health Promotion Center at OU Health Stephenson Cancer Center, and a team of University of Oklahoma researchers, has revealed financial incentives can significantly increase smoking cessation rates among socioeconomically disadvantaged adults.

Smoking has long been known to be a substantial threat to public health. It can lead to a number of poor health outcomes, and is a major contributor to lung cancer, responsible for approximately 85% of all cases. The release of the U.S. Surgeon General’s Report on Smoking and Health in 1964 provided clear evidence linking smoking to numerous health issues, marking the first time the U.S. government had officially recognized its, which in turn, led to campaigns aimed at reducing tobacco use including putting warning labels on cigarette packages, restricting tobacco advertising in the media, and eventually, introducing smoking bans in various public places.

Despite these efforts, many individuals continue to smoke. The habit is particularly common among lower socioeconomic groups with research showing adults with a household income below $35,000 are more than twice as likely to smoke compared to those with an income of $75,000 or more. Data in the Centers for Disease Control and Prevention (CDC)’s 2022 Behavioral Risk Factor Surveillance System (BRFSS) specifically revealed the rates are 29.5% to 12.8%, respectively.

Low-Income Financial Incentives Make Smoking Cessation Successful
Photo by Aphiwat chuangchoem from Pexels

Given these facts, health organizations, regulators, and advocates continue to attempt to reduce smoking rates across the nation, and the team responsible for the new study wanted to determine whether offering monetary incentives to low-income earning adults could be a successful way to encourage quitting. More specifically, the team studied whether combining financial incentives with traditional smoking cessation supports such as counseling and nicotine replacement therapy would be effective.

Participants were divided into two groups with one receiving standard smoking cessation approaches, while the other group received these treatments along with financial incentives for remaining abstinent. The incentives started at $20 weekly and increased incrementally by $5 each week the participants refrained from smoking. Participants were also given an opportunity to earn $50 booster payments for refraining for up to eight and twelve weeks. To determine whether the participants had actually abstained, the team used a carbon monoxide monitor designed to detect the habit.

At the end of the 26-week trial, an estimated 23.5% of participants who received financial incentives were smoke-free, compared to only 12.1% of those who only received traditional treatments. All in all, the introduction of monetary rewards sustainability increased the chances of remaining smoke-free among low-income earning adults.

Dr. Kendzor stated, “It’s an amazing finding that smoking quit rates were doubled at final follow-up simply by offering small incentive payments for quitting.” She attributed this to several factors, including increasing external motivation, being willing to engage in counseling services, and sticking with medication protocols, believing the three factors combined optimized results.

Unsatisfied with simply stopping here, though, Dr. Kendzor is now researching new and innovative methods to apply the findings to a broader population. She is also working with the Oklahoma Tobacco Settlement Endowment Trust (TSET) to apply similar financial incentives through the Oklahoma Tobacco Helpline.


Financial incentives found to double smoking cessation rate for people with socioeconomic challenges

WHO: Lung Cancer

Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial | Lifestyle Behaviors

Improving Tobacco-Related Health Disparities

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