Podcast: Can rewards help smokers to quit in the long term?

Smoking is still the biggest cause of preventable death worldwide and there are more than 50 Cochrane Reviews of the effects of interventions to help people quit. One of these, on the use of incentives, which was last published in 2015 was updated in July 2019. We asked the new lead author, Caitlin Notley, from the University of East Anglia in the UK to bring us up to date with the evidence.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Smoking is still the biggest cause of preventable death worldwide and there are more than 50 Cochrane Reviews of the effects of interventions to help people quit. One of these, on the use of incentives, which was last published in 2015 was updated in July 2019. We asked the new lead author, Caitlin Notley, from the University of East Anglia in the UK to bring us up to date with the evidence.

Caitlin: As well as its impact on premature death, smoking is also a major cause of health inequalities, with higher smoking rates among people of lower socioeconomic status, those with mental health conditions and those who are homeless, for example. In our updated review, we’ve combined the information from trials conducted worldwide where smokers were offered incentives to quit, such as vouchers or money. We only looked at studies that followed people up for at least 6 months and we now have findings from 33 trials, including more than 21,000 participants. 
The size of the financial incentive varied considerably between trials, from zero in which people made self-deposits, to amounts from £35 or US$45 to about £912, or nearly US$1200, but we did not find any evidence that bigger amounts were more effective than smaller ones. 
However, there is high-certainty evidence that incentives improve smoking cessation rates for at least six months. We also found that incentives might continue to have a significant impact on sustained smoking cessation, even after the incentives have finished, which is a new finding in this update.
People offered incentives were 50% more likely to stop smoking than those who did not receive incentives. This means that, among people not receiving incentives, approximately 70 in a thousand were still quit from smoking 6 months later, but this rose to 105 per thousand among people receiving incentives. While these amounts sound small, this is an important difference given how extremely hard it is for people to quit smoking, and given the huge impact on health and wellbeing in the long term, as well as costs to health systems in treating smoking-related disease in people who continue to smoke. If we can do anything at all to help people stop smoking, no matter how small, it is worthwhile. 
Our updated review also includes a new section on the trials supporting pregnant women to quit smoking. Although there are fewer trials, and the quality of trials was lower overall, results were consistent with our main findings, showing that incentives are effective in helping pregnant women to quit smoking. It also now suggests that incentives could work for some hard to reach groups who have very high rates of smoking, such as people who are in treatment for substance misuse. 
In summary, incentives offer an important route to smoking cessation that is effective and may add value to a comprehensive public health approach to reducing smoking prevalence, alongside other forms of cessation support and tobacco control, such as nicotine replacement therapy, pharmacotherapy, behavioural support, and switching to using e-cigarettes.”

Monaz: If you would like to read Caitlin’s full review on incentives to help people quit smoking, you can find it at Cochrane Library dot com with a simple search for 'incentives for smoking cessation'. You can also find the Cochrane evidence on the other interventions she mentioned, by going to the website and browsing the reviews from the Cochrane Tobacco Addiction Group.

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