Smoking kills one in two regular smokers, but quitting at any point in life leads to big improvements in health, increased life expectancy and savings in healthcare costs. That's why we need a range of ways to help people quit - and new evidence shows that paying people to quit is one way to boost quit rates.
Our recently updated Cochrane review looked at the evidence from 33 trials and found strong evidence that incentive programmes help people to quit smoking, increasing quit rates at six months or longer by about 50%. In these programmes, smokers who could prove they'd quit smoking were rewarded financially. Some have expressed concern that smokers would return to smoking once the financial rewards ended, but the studies showed that people stayed smoke free, even after the rewards finished.
Financial incentives can come in all shapes and sizes. In our review, they ranged from vouchers for goods or services, to actual money. We didn't find any evidence that success varied based on the amount of the reward, but more studies are needed to investigate this. Some studies paid people money, others were deposit programmes where people deposited their own money at the start and then had the chance to earn it back by staying smoke free.
There was no evidence that the success rates were different when it was a deposit programme. It might be harder to attract smokers to take part in a deposit programme, but they might be more attractive for programme providers worried about the cost or potential backlash of paying smokers to quit.
There are compelling reasons why paying people to quit might help them. Financial incentives can reward the desired behaviour of being smoke free. Paying people may also offer the benefit of an immediate positive outcome of stopping smoking, providing instant gratification, as many find it difficult to think about the longer-term health benefits of stopping smoking.
That's why it's encouraging that more and more programmes do this - including programmes that help pregnant women stop smoking and programmes for people with a history of substance misuse.
Providing incentives as a way to help people quit, however, presents different challenges to offering support through, say, quitlines or counselling. Though quit rates among these different approaches appear broadly similar, some people worry that non-smokers will enrol on the financial-reward programmes just to get paid.
But most programmes test the levels of smoking-related chemicals in participants' blood, breath or urine before allowing them on the programme, so this is unlikely to happen. Also, there's no evidence of this kind of deception regularly occurring.
In other cases, there are concerns about how certain programmes reward quitting. For example, the tobacco firm Philip Morris recently launched an insurance company that includes financial benefits for smokers who quit. The amount of the benefit depends on how they quit and whether they use other Philip Morris products to do so.
Some people object, in principle, to paying people to quit as it may be seen as unfair that non-smokers receive nothing in comparison. After all, people who've never smoked aren't eligible for such programmes. This is an important point to address because public acceptance of public health interventions is key to their success.
Of course, on some level, these programmes are rewarding smokers, but it is difficult to conceive that anyone would start smoking just to enter such a programme. The vast majority of smokers start young, influenced by billions spent on advertising directly targeting them. In this scenario, smoking is not a free choice; it's a behaviour constrained by social influence that can become an addiction.
Most smokers want to quit. They know smoking is bad for their health; they know it is costing them and society dearly, but cigarettes have been designed to make quitting really difficult. As a society, if there's anything we can do to make this easier, shouldn't we?
Authors: Jamie Hartmann-Boyce - Senior Researcher, Health Behaviours, University of Oxford | Caitlin Notley - Senior Lecturer in Mental Health, University of East Anglia