title: The effect of financial incentives on top of behavioral support on quit rates in tobacco smoking employees: study protocol of a cluster-randomized trial.
abstract: Stimulating successful tobacco cessation among employees has multiple benefits. Employees who quit tobacco are healthier, more productive, less absent from work, and longer employable than employees who continue to use tobacco. Despite the evidence for these benefits of tobacco cessation, a successful method to stimulate employees to quit tobacco is lacking. The aim of this study is to evaluate whether adding a financial incentive to behavioral support (compared with no additional incentive) is effective and cost-effective in increasing abstinence rates in tobacco smoking employees participating in a smoking cessation group training.
  
  
  
  In this cluster-randomized trial employees in the intervention and control group both participate in a smoking cessation group training consisting of seven weekly counseling sessions of ninety minutes each. In addition to the training, employees in the intervention group receive a voucher as an incentive for being abstinent from smoking at the end of the training (€50), after three months (€50), after six months (€50), and after one year (€200). The control group does not receive any incentive. The primary outcome is carbon monoxide validated 12-month continuous abstinence from smoking (Russel's standard). Additionally, an economic evaluation is performed from a societal and an employer perspective.
  
  
  
  The present paper describes the methods and design of this cluster-randomized trial in detail. We hypothesize that the financial incentive for abstinence in the form of vouchers increases abstinence rates over and above the group training. The results of this study can provide important recommendations for enhancement of employee tobacco cessation.
  
  
  
  Dutch Trial Register: NTR5657 . First received 27-01-2016.
authors.affiliation: Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA, Maastricht, Netherlands. f.vandenbrand@maastrichtuniversity.nl.
authors.forename: F A
authors.initials: FA
authors.lastname: van den Brand
authors.affiliation: Department of Health Promotion/Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA, Maastricht, Netherlands.
authors.forename: G E
authors.initials: GE
authors.lastname: Nagelhout
authors.affiliation: Department of Methodology and Statistics, Maastricht University, P. Debyeplein 1, 6229 HA, Maastricht, Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Winkens
authors.affiliation: Department of Health Services Research, Maastricht University (CAPHRI), Duboisdomein 30, 6229 GT, Maastricht, Netherlands.|Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluations, Utrecht, Netherlands.
authors.forename: S M A A
authors.initials: SM
authors.lastname: Evers
authors.affiliation: Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA, Maastricht, Netherlands.|Department of Institute of General Practice, Heinrich-Heine University, P.O. Box 101007, 40001, Düsseldorf, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Kotz
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, Netherlands.
authors.forename: N H
authors.initials: NH
authors.lastname: Chavannes
authors.affiliation: Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA, Maastricht, Netherlands.
authors.forename: C P
authors.initials: CP
authors.lastname: van Schayck
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling / Q000379:methods*; D005260:Female; D006126:Group Processes; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009042:Motivation; D009786:Occupational Health Services; D012107:Research Design; D012201:Reward; D012907:Smoking / Q000191:economics / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods*
keywords: Employees; Incentives; Intervention; Reward; Smoking cessation; Tobacco