Financial incentives for abstinence among socioeconomically disadvantaged individuals in smoking cessation treatment

Abstract

Objectives: We evaluated the effectiveness of offering adjunctive financial incentives for abstinence (contingency management [CM]) within a safety net hospital smoking cessation program.

Methods: We randomized participants (n = 146) from a Dallas County, Texas, Tobacco Cessation Clinic from 2011 to 2013 to usual care (UC; cessation program; n = 71) or CM (UC + 4 weeks of financial incentives; n = 75), and followed from 1 week before the quit date through 4 weeks after the quit date. A subset (n = 128) was asked to attend a visit 12 weeks after the scheduled quit date.

Results: Participants were primarily Black (62.3%) or White (28.1%) and female (57.5%). Most participants were uninsured (52.1%) and had an annual household income of less than $12 000 (55.5%). Abstinence rates were significantly higher for those assigned to CM than UC at all visits following the quit date (all Ps < .05). Point prevalence abstinence rates in the CM and UC groups were 49.3% versus 25.4% at 4 weeks after the quit date and 32.8% versus 14.1% at 12 weeks after the quit date. CM participants earned an average of $63.40 ($150 possible) for abstinence during the first 4 weeks after the scheduled quit date.

Conclusions: Offering small financial incentives for abstinence might be an effective means to improve abstinence rates among socioeconomically disadvantaged individuals participating in smoking cessation treatment.

Figures

FIGURE 1—

Participant flow diagram: Financial Incentives for Abstinence in Smoking Cessation Treatment; Dallas County, TX; 2011–2013.

FIGURE 2—

Biochemically verified point prevalence abstinence by treatment group and gender: Financial Incentives for Abstinence in Smoking Cessation Treatment; Dallas County, TX; 2011–2013. Note. CM = contingency management; UC = usual care. A subsample of 128 participants was asked to complete the follow-up visit 12 weeks after the quit date. Values reflect 7-day point prevalence abstinence at all visits except for the quit date, which reflects approximately 12 hours of abstinence. Intervention group differences in abstinence rates were significant at all visits except for the quit date in both unadjusted and adjusted analyses (all Ps < .05).