Want to Quit Smoking? Put Your Money on the Line


CVS Pharmacy made headlines in the fall of 2014 with the announcement they would no longer sell tobacco products in their stores. The decision, which the company estimated would cut their annual gross revenues by $2 billion, was part of a rebranding strategy to position CVS Health (their new name) as a healthcare provider.  CVS is again making news with an innovational study that looks at the effectiveness of different reward programs in getting people to quit smoking. The study, published May 14 in the New England Journal of Medicine, had some interesting results.

The study randomly assigned 2,538 participants, all CVS employees, their families and friends, to one of four smoking cessation reward programs. Two programs took a group approach with groups of six participants competing with or working collaboratively with their group members to increase rewards. Two programs took an individual approach. All participants had the option of dropping out of the study once they were assigned to a program.

Think you can kick the habit? Would you bet $150 on it?

Two different types of reward programs were used. With one program, individuals and groups earned cash rewards at intervals of two weeks, 30 days, and six months if they abstained from smoking during those periods. The other program required participants put down a $150 deposit of their own money, which they would lose if they did not quit smoking. If they did quit, they would get back their deposit and additional cash rewards. The maximum per-person reward for all programs was $800, however this amount includes refund of the $150 deposit for those in the deposit programs, therefore, participants in these programs could, at most, see a net gain of $650.

Having some skin in the game made a difference

Smokers assigned to the deposit programs were more likely to not accept the program and leave the study. The higher participation rate in the straight rewards programs made these programs more successful. However, those who did put their own money on the line quit smoking at a rate nearly 14 percent greater than those who had made no investment. This suggests that “loss aversion” is a strong incentive to change behavior. There was little difference in results between the group programs and the individual programs. Overall, the smoking cessation rate of participants was triple that of previous interventions such as offering nicotine replacement therapies.

Looking to the future

Although smoking rates have declined, smoking continues to be the leading cause of preventable death in the United States. A 2013 Ohio State University study concluded that every smoker costs their employer an additional $5,816 a year in lost work time and health care expenses. Many businesses offer employees incentives to quit, such as paying for smoking cessation programs. The CVS Health study suggests that offering financial incentives may be more effective in reducing smoking rates.

Ex-smoker wannabes can come away from the study with this message: Don’t hesitate to enroll in one of these deposit-type programs if your employer offers one. Your chances of success are good. The concept of using monetary penalties to incentivize desired behavior has helped people reach nutrition and exercise goals through the smartphone Pact app. Perhaps a smoking cessation app that exacts fines for lighting up is on the horizon.