Smoking is the leading cause of preventable mortality in United States, accounting for approximately 435,000 of the 2.4 million deaths each year in the United States. Most smokers make multiple attempts to quit smoking, but only 2-3% succeed each year. Smoking cessation programs and pharmacological aids have proven effective in helping smokers quit, but only about 5% of smokers enroll in smoking cessation programs each year. The current prevalence of smokers in the United States is about 22%, meaning that achieving the Healthy People 2010 goal of having 12% or fewer current smokers in the adult population will require substantial increases in tobacco cessation rates. The investigators propose to conduct a randomized control trial (RCT) of financial incentives for smoking cessation among employees at General Electric worksites throughout the United States. This will be a 2-arm RCT in which smokers will get randomized to receive either usual care (information about local community-based smoking cessation resources, coverage of prescription drugs and physician visits) or usual care plus a package of financial incentives that includes $250 for completion of a community-based tobacco cessation program, $250 for smoking cessation 30 days post-quit date, and $250 for smoking cessation 6 months post-quit date (biochemically confirmed). Financial incentives have been shown to increase enrollment in smoking cessation programs and short-term quit rates, but have not been well tested as a mechanism for increasing long-term quit rates. The existing evidence suggests that they could be highly effective, particularly among heavy smokers and low income smokers. In addition, financial incentives for smoking cessation will likely be more cost effective than most covered health services and at least as cost effective as other recommended smoking cessation treatments. The primary outcome will be quit rates at 6 months. Secondary outcomes will be enrollment in and completion of community-based smoking cessation programs, 30-day and 12-month quit rates, and cost effectiveness of the incentives in increasing quit rates. The proposed intervention, designed to be highly cost effective and easy to replicate in employer settings, has the potential to substantially reduce the economic and health burden of smoking-related disease and disability among a large portion of the American population.
| Volpp, Kevin G; Troxel, Andrea B; Pauly, Mark V et al. (2009) A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med 360:699-709 |
| Volpp, Kevin G; Pauly, Mark V; Loewenstein, George et al. (2009) P4P4P: an agenda for research on pay-for-performance for patients. Health Aff (Millwood) 28:206-14 |
