Effectiveness of a small cash incentive on abstinence and use of cessation aids for adult smokers: A randomized controlled trial

- A small cash incentive can motivate adult smokers to have quit attempt, but cannot increase abstinence.
- The small incentive did not increase quit attempts with medication and cessation services.
- Large incentive and encouragement of using existing cessation resources are needed.

BackgroundLarge amount of financial incentive was effective to increase tobacco abstinence, but the effect of small amount is unknown.PurposeWe evaluated if a small amount of cash incentive (HK$500/US$64) increased abstinence, quit attempt, and use of cessation aids.MethodsA three-armed, block randomized controlled trial recruited 1143 adult daily smokers who participated in the Hong Kong “Quit to Win” Contest. Biochemically validated quitters of the early-informed (n = 379, notified about the incentive at 1-week and 1-month follow-up) and the late-informed incentive group (n = 385, notified at 3-month follow-up) received the incentive at 3 months. The validated quitters of the control group (n = 379) received the incentive at 6 months without prior notification. All subjects received brief advice, a self-help education card and a 12-page booklet. The outcomes were self-reported 7-day point prevalence of abstinence, quit attempt (intentional abstinence for at least 24 h) and use of cessation aids at 3-month follow-up.ResultsBy intention-to-treat, the early-informed group at 3-month follow-up reported a higher rate of quit attempt (no smoking for at least 24 h) than the other 2 groups (44.1% vs. 37.4%, Odds ratio (OR) = 1.32, 95% CI 1.03-1.69, p = 0.03), but they had similar abstinence (9.2% vs. 9.7%, OR = 0.95, 95% CI 0.62, 1.45). The early- and late-informed group showed similar quitting outcomes. The early-informed group reported more quit attempts by reading self-help materials than the other 2 groups (31.4% vs. 25.3%, OR = 1.56, 95% CI 1.12-2.18, p < 0.01).ConclusionsThe small cash incentive with early notification increased quit attempt by “self-directed help” but not abstinence. Future financial incentive-based programmes with a larger incentive, accessible quitting resources and encouragement of using existing smoking cessation services are needed.