Financial incentives for smoking cessation in low-income smokers: study protocol for a randomized controlled trial.
BACKGROUND
Tobacco smoking is the leading avoidable cause of death in high-income countries. The smoking-related disease burden is borne primarily by the least educated and least affluent groups. Thus, there is a need for effective smoking cessation interventions that reach to, and are effective in this group. Research suggests that modest financial incentives are not very effective in helping smokers quit. What is not known is whether large financial incentives can enhance longer-term (1 year) smoking cessation rates, outside clinical and workplace settings.


METHODS
A randomized, parallel groups, controlled trial.


METHODS



METHODS
Eight hundred low-income smokers in Switzerland (the less affluent third of the population, based on fiscal taxation).


METHODS
A smoking cessation program including: (a) financial incentives given during 6 months; and (b) Internet-based counseling. Financial rewards will be offered for biochemically verified smoking abstinence after 1, 2, and 3 weeks and 1, 3, and 6 months, for a maximum of 1,500 CHF (1,250 EUR, 1,500 USD) for those abstinent at all time-points. All participants, including controls, will receive Internet-based, individually-tailored, smoking cessation counseling and self-help booklets, but there will be no in-person or telephone counseling, and participants will not receive medications. The control group will not receive financial incentives.


OBJECTIVE
To increase smoking cessation rates.


RESULTS
Smoking abstinence after 6 and 18 months, not contradicted by biochemical tests. We will assess relapse after the end of the intervention, to test whether 6-month effects translate into sustained abstinence 12 months after the incentives are withdrawn.Randomization: Will be done using sealed envelopes drawn by participants.Blinding: Is not possible in this context.


CONCLUSIONS
Smoking prevention policies and interventions have been least effective in the least educated, low-income groups. Combining financial incentives and Internet-based counseling is an innovative approach that, if proven acceptable and effective, could be later implemented on a large scale at a reasonable cost, decrease health disparities, and save many lives.


BACKGROUND
Current Controlled Trials ISRCTN04019434.
Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, CMU - 1 rue Michel-Servet, 1211, Geneva 4, Switzerland. Jean-Francois.Etter@unige.ch
Jean-François
JF
Etter
D003376:Counseling; D006801:Humans; D009042:Motivation; D010174:Pamphlets; D011203:Poverty / Q000191:economics*; D012008:Recurrence; D012107:Research Design; D012201:Reward; D012907:Smoking / Q000191:economics / Q000523:psychology; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods / Q000523:psychology; D000074606:Smoking Prevention; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome