Financial incentives are a more effective way to get employees to quit smoking than offering free deterrents such as nicotine patches or e-cigarettes, according to a study in the New England Journal of Medicine. The trial also provided large-scale, randomized evidence that the offer of free e-cigarettes does not result in higher rates of sustained abstinence than traditional smoking-cessation aids.

The findings “suggest that employers could make their wellness programs more effective by offering money to get their employees to stop smoking instead of or in addition to cessation aids,” Scott D. Halpern, M.D., Ph.D., of the University of Pennsylvania Perelman School of Medicine, told Psychiatric News. Additionally, “they suggest that e-cigarettes may not be an effective component of a global anti-smoking campaign and may even derail this effort.”

Halpern and colleagues assigned more than 6,000 workers from 54 U.S. companies and their spouses who were current smokers to one of four smoking-cessation interventions or to usual care only. Usual care consisted of access to information regarding the benefits of smoking cessation and a motivational text-messaging service. The four interventions consisted of usual care plus one of the following free cessation aids: nicotine-replacement therapy or pharmacotherapy (with e-cigarettes if standard therapies failed), free e-cigarettes (without a requirement that standard therapies fail), free cessation aids plus $600 in earned rewards for sustained abstinence, or free cessation aids plus $600 deposited in an account, with money removed from the account if cessation milestones were not met.

After six months, sustained abstinence rates were 0.1% in the usual-care group, 0.5% in the free cessation-aids group, 1.0% in the free e-cigarettes group, 2.0% in the rewards group, and 2.9% in the redeemable-deposit group. Three between-group comparisons met the criteria for statistical significance with respect to sustained abstinence: redeemable deposits were superior to free cessation aids, rewards were superior to free cessations aids, and redeemable deposits were superior to free e-cigarettes. The sustained abstinence rates in the free e-cigarettes group, free cessation-aids group, and usual-care group did not differ significantly.

“Whether you look at all smokers or only those who are motivated to quit,” said Halpern, “paying people to stop smoking is the most effective and most cost-effective thing that employers or insurers could do to promote cessation. People who are thinking of using e-cigarettes, and FDA officials who are thinking of regulating e-cigarettes, should know that the best evidence we have suggests that e-cigarettes don’t help people quit.”

For related information, see the Psychiatric News article “National Academies Report Details Health Impact of E-Cigarettes.”

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