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Want to help people quit smoking? Bribe them, study finds

Smoking is more of a crippling addiction than the “nasty habit” detractors make it out to be, but one thing is for certain: Smoking is a major public health issue. While it’s true that efforts and campaigns to end smoking have resulted in a dramatic reduction in the number of smokers in the U.S., tobacco companies are still among the most reliable investments on Earth. Short of outlawing tobacco (which will never happen), there’s little hope for a smoke-free America any time soon. However, one study from the University of Pennsylvania’s Perelman School of Medicine shows promise: If you want smokers to quit, give them some kin in the game.

For the study, researchers enrolled 2,538 participants from across the United States for an eight month trial in 2012. The smokers were then placed into one of five groups: Individual reward, collaborative reward (based on group performance), individual deposit (requiring an upfront deposit of $150 with subsequent matching funds), competitive deposit (competing for other participants’ deposits and matching funds) or traditional care, which involved counseling and nicotine replacement therapy.

Unsurprisingly, the reward programs was the overall winner, with 90% of participants accepting placement in either the individual or group reward groups. 16% of those people were smoke-free after six months, compared to 10% in the deposit groups and 6% in the traditional care programs.

However, cut a different way, the data tells another story. The reward programs hogged the spotlight because more people accepted them in the first place. With such a large majority opting into one group it’s bound to yield the best results. However, something else may be at play:

“However, among people who would have accepted any program we offered them, the deposit contracts were twice as effective as rewards, and five times more effective than free information and nicotine replacement therapy, likely because they leveraged people’s natural aversion to losing money. With such unprecedented rates of success, the trick now is to figure out how to get more people to sign up — to feel like they have skin in the game,” said said lead author Scott D. Halpern, MD, PhD.

It will likely hinge on how much money anyone attempting such a program will ask of its participants. A $150 outlay may be manageable for some, but it’s a princely sum for others. The sweet spot rests on finding an amount that’s high enough to matter to individuals, but not so much that a person would lose their shirt in attempting a monumentally difficult task.

CVS Health, which famously stopped selling cigarettes and other tobacco products in their pharmacies, will be among the first companies to implement a deposit program. Called “700 Good Reasons,” the campaign will give all employees who smoke the opportunity to deposit $50 in a wager that they can quit. If they test clean for tobacco after one year, they get their $50 back along with $700 more.

“As we continue to see smoking as the number one cause of preventable death in the United States, it’s important for employers to consider different options to use benefit design to help their workers quit,” said senior author Kevin Volpp, MD, PhD, a professor of Medicine and Health Care Management in the School of Medicine. “When compared to the estimated $4,000 to 6,000 incremental annual cost associated with employing a smoker over a non-smoker, a $700 to 800 incentive paid only to those who quit seems well worth the cost.”

The deposit program is a breakthrough, but it isn’t a cure-all. Some people may well respond to rewards better than they do to the risk of losing money. Furthermore, peoples’ genetic makeup affects how likely they are to smoke, as well as how likely they are to quit smoking. Nonetheless, this is the greatest advancement in smoking cessation since the invention of the nicotine patch.