THE USE AND IMPACT OF INCENTIVES IN POPULATION-BASED SMOKING CESSATION PROGRAMS - A REVIEW

Purpose. This review discusses current published literature on populat ion-based smoking cessation interventions that involve incentives and examines whether such interventions are effective in reducing the prev alence of smoking. Search Method. Studies published between 1975 and S pring 1997 were identified through a computerized seal ch of four elec tronic databases (MEDLINE, HEALTH, CINAHL, and PSYCINFO) and reference lists of key articles using the following key words: (smoking cessati on OR quit smoking) AND (contest OR competition OR incentive OR lotter y OR quit and win). This search yielded 79 articles. To be included, s tudies had to be published in English and had to have presented either quit rates or participation rates for an incentive-based program that used population-based recruitment. Of the 79 articles, 17 met these c riteria. Findings. Population-based interventions generally attract 1 to 2 % of the target population, but these participation rates can pot entially be increased through the use of innovative recruitment techni ques. No specific type of recruitment strategy was shown to be consist ently more effective than others. There is no evidence that particular types of incentives are able to influence participation or quit rates , but the size of an incentive does appear to be important, with large r incentives viewed as more effectively motivating smokers to quit and stay smoke free than smaller ones. Estimates of the cost per quitter have ranged from less than $20 to over $400. There are some indication s that the costs of such programs compare favorably with smoking cessa tion classes or clinic-based approaches. Conclusion. Incentive-based s moking cessation programs that target an entire community have the adv antage of reaching a large and diverse group of smokers. They may, how ever, attract only smokers who are already motivated to quit. Realisti cally incentive-based programs aimed at the general population can exp ect 1 % of all their smokers to quit smoking. Quit rates among partici pants may initially be high (i.e., mean quit rate of 34% at 1-month fo llow-up) but decrease over time (i.e., mean rate of 23 % at 1 year). T he results of this review suggest a continued need to establish standa rd and valid criteria for the evaluation of smoking cessation interven tions, Methodological differences among existing studies make them dif ficult to compare and interpret.