Is This the Best Way to Get Smokers to Quit?

Are smokers more likely to quit with a carrot or a stick? A new study hints at the answer. (Photo: Getty Images)

Ask any former smoker and you’ll hear something along these lines: “Quitting was the hardest thing I’ve ever had to do.” And for all of those who do quit, there are many more who have tried and failed: The American Cancer Society reports that only about 4 to 7 percent of smokers are able to quit on any given attempt without medicine or other help.

That’s why new research published in the New England Journal of Medicine is so significant. Scientists discovered that people who followed a penalty-based program to quit smoking were twice as likely to be successful as those who did a more traditional reward-based program.

The study followed 2,538 CVS Caremark employees and their loved ones who smoked. They were assigned to one of two smoking-cessation programs — a reward-based one, and a penalty-based one — and then were given an option to participate. Ninety percent of the ones assigned to a reward-based program opted to actually participate, while just 13.7 percent of those assigned a penalty or deposit-based program chose to move forward.

(The reward-based programs offered $800 for people who successfully quit smoking, while the penalty-based programs offered a refundable deposit of $150 plus $650 in reward money for those who quit.)

While both types of programs were more successful in getting smokers to quit than people who tried to quit on their own, the penalty-based program had a significantly higher rate of success.

Lead researcher Scott Halpern, MD, an assistant professor of medicine at the University of Pennsylvania, tells Yahoo Health that he’s pleased with the findings but was surprised that so few people opted for the penalty-based program, despite its increased effectiveness.

According to the Centers for Disease Control and Prevention, an estimated 42.1 million adults currently smoke cigarettes. Cigarette smoking is also responsible for more than 480,000 deaths every year. Most smoking cessation programs offered by employers offer reward-based programs, but these new findings may help encourage them to consider a penalty-based program.

However, Michael Fiore, MD, director of the University of Wisconsin Center for Tobacco Research and Intervention, is quick to point out that both programs worked. “When we think about the fact that every smoker costs about $1,600 a year, on average, in extra health care costs, you can see that these type of programs really are a smart investment,” he tells Yahoo Health.

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That’s a sentiment echoed by Deborah Ossip, PhD, director of the Smoking Research Program in the Department of Public Health Sciences at the University of Rochester Medical Center. She says it makes sense that most employers offer a reward-based program, especially since this study showed that it was difficult to get people to opt for a penalty-based program in the first place, but stresses that they may want to consider adding a penalty-based program as well given its success rate and the overall success rate of people who followed any type of program.

“The choice is important,” she tells Yahoo Health. “We like to feel in control of our destiny, and you may be able to maximize your effectiveness by offering two options.”

But why was the penalty-based program so effective? Ossip says it may have been because people who chose to do it were more confident in their ability to quit. “One of the most consistent predictors of success with smoking abstinence is believing that you can do it,” she says.

Related: Smoking in US Declines to All-Time Low

Halpern says the risk of losing money may also have come into play: “People are loss-averse. We’re all much more loathe to lose $150 than we are excited to gain $150.”

Halpern is hopeful that his findings will generate a lot of attention with large employers, and notes that CVS is changing its wellness program for smokers to a deposit-based program if they can quit smoking for up to a year.

“The findings are exciting,” says Ossip. “They show that we need to be thinking of creative approaches for quitting because tobacco is still the No.1 cause of preventable death and disability in the U.S.”

If you or a loved one wants help quitting smoking, please call 1-800-QUIT-NOW or visit SmokeFree.gov for more information.

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