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Offering free patches to employees who smoke doesn't help them quit - but giving them money does

A new US study found workers were three times more likely to quit if there was a financial incentive.

Image: Shutterstock/Daniel Heighton

A NEW STUDY has found offering free smoking cessation aids as part of corporate wellness programmes does not help workers quit the habit, but giving them financial incentives does.

Aids such as nicotine patches and chewing gum are often used by US companies to promote wellness and encourage employees to quit smoking. Now a study from the Perelman School of Medicine at the University of Pennsylvania has found this does not actually help. Financial incentives, however, are three times more effective.

This study also provides the first large-scale evidence that offering e-cigarettes to known smokers is not effective at helping smokers stay smoke-free. The results are published in the New England Journal of Medicine and may hold significant policy implications as the US Food and Drug Administration continues to weigh e-cigarette regulation.

Lead author Scott D. Halpern said the study drives forward previous research by showing that even among smokers who are not cherry picked on the basis of their motivation to quit, “financial incentives still triple quit rates, whereas offering free conventional cessation aids or free e-cigarettes accomplishes nothing at all”.

The study enrolled more than 6,000 participants from across 54 US-based companies. Participants were assigned to one of four smoking cessation intervention groups or usual care.

Smoking cessation interventions included usual care plus one of the following:

  • free e-cigarettes, in flavors of participants’ choosing;
  • free cessation aids (nicotine patches, gum, and other medications, with free e-cigarettes only available for participants who’ve tried standard therapies previously)
  • free cessation aids plus $600 in rewards for sustained abstinence from smoking; or
  • free cessation aids plus $600 in redeemable funds, which were deposited in an account for each participant and removed if smoking cessation milestones were not met.

The study found that overall, only 1.3% of participants remained smoke-free for at least six months. However, the quit rates for redeemable deposits were significantly higher than with free cessation aids or with free e-cigarettes, and the quit rate for the rewards group was also higher than for cessation aids.

By contrast, no differences were found in the quit rates among participants assigned to free e-cigarettes, free cessation aids, or usual care.

Of the more than 6,000 participants enrolled in the trial, 1,191 actively engaged with their assigned program. Those engaged in the trial were more motivated to quit, making them similar to smokers enrolled in prior studies that only enrolled participants who expressed an active interest in quitting.

These motivated smokers were four to six times more likely to stay smoke-free for six months after the target quit date compared to those who did not actively engage. The authors say the quit rates observed among these engaged participants are consistent with those found in prior studies of incentives among motivated smokers.

However, in the new study, even among these engaged participants, neither free e-cigarettes nor free cessation aids produced higher quit rates than usual care.

“Knowing that offering free e-cigarettes does not help smokers quit should inform the policies being deliberated at the FDA regarding whether or how to regulate e-cigarettes,” Halpern said.

“The result is concerning because it suggests that e-cigarettes may do more harm than good.”

A study by the National Academy of Science, Engineering, and Medicine concluded earlier this year that if e-cigarette use by adult smokers does not “lead to long-term abstinence from combustible tobacco cigarettes,” then “e-cigarette use could cause considerable harm to public health in the short- and long-term.”

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