title: Effects of Large Financial Incentives for Long-Term Smoking Cessation: A Randomized Trial.
abstract: It is not known whether large financial incentives enhance long-term smoking cessation rates outside clinical or workplace settings.
  
  
  
  The goal of this study was to test whether large financial incentives improved long-term smoking cessation rates in low-income smokers, in a general population setting, without face-to-face or telephone counseling.
  
  
  
  This was a 2-arm, parallel group, individually randomized controlled trial, with follow-up after 3, 6, and 18 months. Participants were 805 low-income smokers enrolled between 2011 and 2013 from the general population in Geneva, Switzerland. We randomly assigned participants to receive either booklets plus access to a smoking cessation website (control group, n = 404), or the same intervention plus financial incentives (intervention group, n = 401). Incremental financial rewards, to a maximum of U.S. $1,650, were offered for biochemically verified abstinence at 1, 2, and 3 weeks, and 1, 3, and 6 months. No in-person counseling, telephone counseling, or medications were provided. The primary outcome was continuous abstinence between 6 months (end of incentives) and 18 months (12 months after the incentives ended), verified by expired carbon monoxide and salivary cotinine. We also assessed biochemically verified 7-day abstinence at 3, 6, and 18 months.
  
  
  
  Rates of continuous abstinence between months 6 and 18 were 9.5% in the incentive group and 3.7% in the control group (p = 0.001). Rates of 7-day abstinence were higher in the incentive group than in the control group at 3 (54.9% vs. 11.9%; p < 0.001), 6 (44.6% vs. 11.1%; p < 0.001), and 18 months (18.2% vs. 11.4%; p = 0.006).
  
  
  
  In low-income smokers who did not receive face-to-face or telephone smoking cessation counseling, large financial incentives increased long-term rates of smoking cessation. (Financial incentives for smoking cessation in low-income smokers; ISRCTN04019434).
authors.affiliation: Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland. Electronic address: jean-francois.etter@unige.ch.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etter
authors.affiliation: Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Felicia
authors.initials: F
authors.lastname: Schmid
mesh_terms: D000328:Adult; D003376:Counseling / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008297:Male; D009042:Motivation; D010353:Patient Education as Topic; D012189:Retrospective Studies; D012201:Reward; D012907:Smoking / Q000191:economics; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods*; D000074606:Smoking Prevention; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome
keywords: contingency management; financial incentives; nicotine; tobacco use disorder