THURSDAY, May 24, 2018 -- Vaping has been touted as a way to help smokers quit, but new research finds e-cigarettes and free nicotine replacement products barely move the motivation needle.
"As best we know right now, the most effective tool to help all smokers stop is to pay them to do so," said the study's lead author, Dr. Scott Halpern. He's an associate professor of medical ethics and health policy at the University of Pennsylvania Perelman School of Medicine in Philadelphia.
Just how much money does the trick?
"Incentives of $600 to $800 triple quit rates," Halpern said. "Smokers tend to overvalue immediate rewards over long-term ones. If they didn't do that, they probably wouldn't smoke at all. And, because the immediate reward is very clearly in the mindset of a smoker, providing a substitute in the form of money seemed to work quite well."
In an effort to mimic strategies of large employers and insurers, researchers offered smoking cessation programs to more than 6,100 smokers from 54 companies. Just 125 people opted out; the rest were included.
The remaining smokers were randomly placed into one of five groups:
- Usual care, which included information on benefits of quitting and motivational text messages.
- Free nicotine replacement therapy or drugs to help them quit, with an offer of e-cigarettes if those methods failed.
- Free e-cigarettes, without a requirement to try other products first.
- Free smoking cessation aids, plus $600 in rewards for sustained abstinence.
- Free cessation aids plus $600 deposited in a bank account for each participant, with money removed from the account if quitting milestones weren't met.
The goal was sustained quitting for at least six months. Urine and blood samples collected at one, three and six months were used to confirm abstinence from cigarettes.
Just 0.1 percent in the usual care group met the goal. In the free nicotine replacement therapy group, only 0.5 percent did, while 1 percent who got free e-cigarettes did so. In the delayed reward group, 2 percent managed to quit for six months and 2.9 percent who were given a bank account upfront stayed cigarette-free for at least six months.
Nearly 1,200 participants really got into it. They were dubbed the "engaged" group and had sustained quit rates four to six times higher than less-engaged members of group.
"None of these interventions produced high cessation rates," Halpern noted. But, he added, "Among the 20 percent motivated to quit, cessation rates were considerably higher."
Halpern pointed out that while e-cigarettes are often touted as a way to quit smoking, this study didn't find good evidence that they do so.
But David Abrams, a professor of social and behavioral sciences at the NYU College of Global Public Health at New York University, countered that this study doesn't prove e-cigarettes don't help.
Abrams said that the study didn't track whether or not participants actually used the nicotine replacement products or e-cigarettes.
In addition, he noted that while more than 6,000 people were invited with instructions to opt out if they didn't want to take part, it's not clear that those who remained in the study had any desire to quit smoking. They might just not have bothered to opt out of the study.
"There's something to be said for trying to reach smokers who aren't ready to quit, and the financial incentives had some effect. But we have to be careful not to make more of the results than is there," Abrams said.
He also pointed out that other recent research has suggested e-cigarettes can be useful in helping smokers quit.
Kenneth Warner, professor and dean emeritus at the University of Michigan School of Public Health in Ann Arbor, said, "Incentives do work. This study is one more confirmation of that."
But, Warner explained that a limitation of this study is that researchers don't know if the incentives worked in the long run. Many smokers relapse in the first and second years of quitting.
He also agreed with Abrams that the study wasn't designed to assess whether vaping is an effective smoking cessation technique.
The new report was published online May 23 in the New England Journal of Medicine. More information
For more on smoking cessation, visit Smokefree.gov.
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