title: Heterogeneity in the Effects of Reward- and Deposit-based Financial Incentives on Smoking Cessation.
abstract: Targeting different smoking cessation programs to smokers most likely to quit when using them could reduce the burden of lung disease.
  
  
  
  To identify smokers most likely to quit using pure reward-based financial incentives or incentive programs requiring refundable deposits to become eligible for rewards.
  
  
  
  We conducted prespecified secondary analyses of a randomized trial in which 2,538 smokers were assigned to an $800 reward contingent on sustained abstinence from smoking, a refundable $150 deposit plus a $650 reward, or usual care.
  
  
  
  Using logistic regression, we identified characteristics of smokers that were most strongly associated with accepting their assigned intervention and ceasing smoking for 6 months. We assessed modification of the acceptance, efficacy, and effectiveness of reward and deposit programs by 11 prospectively selected demographic, smoking-related, and psychological factors. Predictors of sustained smoking abstinence differed among participants assigned to reward- versus deposit-based incentives. However, greater readiness to quit and less steep discounting of future rewards were consistently among the most important predictors. Deposit-based programs were uniquely effective relative to usual care among men, higher-income participants, and participants who more commonly failed to pay their bills (all interaction P values < 0.10). Relative to rewards, deposits were more effective among black persons (P = 0.022) and those who more commonly failed to pay their bills (P = 0.082). Relative to rewards, deposits were more commonly accepted by higher-income participants, men, white persons, and those who less commonly failed to pay their bills (all P < 0.05).
  
  
  
  Heterogeneity among smokers in their acceptance and response to different forms of incentives suggests potential benefits of targeting behavior-change interventions based on patient characteristics. Clinical trial registered with www.clinicaltrials.gov (NCT 01526265).
authors.affiliation: 1 Department of Medicine.|2 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics.|3 Department of Biostatistics and Epidemiology.|4 Department of Medical Ethics and Health Policy, and.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
authors.affiliation: 2 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics.|3 Department of Biostatistics and Epidemiology.
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.affiliation: 2 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics.|5 Department of Statistics and.
authors.forename: Dylan S
authors.initials: DS
authors.lastname: Small
authors.affiliation: 2 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics.|3 Department of Biostatistics and Epidemiology.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Saulsgiver
authors.affiliation: 3 Department of Biostatistics and Epidemiology.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Harhay
authors.affiliation: 2 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics.|6 Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Janet
authors.initials: J
authors.lastname: Audrain-McGovern
authors.affiliation: 2 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics.|7 Center for Behavioral Decision Research, Carnegie Mellon University, Pittsburgh, Pennsylvania.
authors.forename: George
authors.initials: G
authors.lastname: Loewenstein
authors.affiliation: 1 Department of Medicine.|2 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics.|4 Department of Medical Ethics and Health Policy, and.|9 Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.|8 Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and.|10 Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.affiliation: 1 Department of Medicine.|2 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics.|4 Department of Medical Ethics and Health Policy, and.|9 Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.|8 Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and.|10 Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Volpp
mesh_terms: D000328:Adult; D000367:Age Factors; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009042:Motivation; D015397:Program Evaluation; D012201:Reward; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention
keywords: behavior change; financial incentives; heterogeneity of treatment effect; smoking cessation