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. 2019 Jul 17;7(7):CD004307.
doi: 10.1002/14651858.CD004307.pub6.

Incentives for smoking cessation

Caitlin Notley  1 , Sarah Gentry, Jonathan Livingstone-Banks, Linda Bauld, Rafael Perera, Jamie Hartmann-Boyce
Affiliations

Incentives for smoking cessation

Caitlin Notley et al. Cochrane Database Syst Rev. .

Update in

  • Incentives for smoking cessation.
    Notley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Conde M, Hartmann-Boyce J. Notley C, et al. Cochrane Database Syst Rev. 2025 Jan 13;1(1):CD004307. doi: 10.1002/14651858.CD004307.pub7. Cochrane Database Syst Rev. 2025. PMID: 39799985 Free PMC article.

Abstract

Background: Financial incentives, monetary or vouchers, are widely used in an attempt to precipitate, reinforce and sustain behaviour change, including smoking cessation. They have been used in workplaces, in clinics and hospitals, and within community programmes.

Objectives: To determine the long-term effect of incentives and contingency management programmes for smoking cessation.

Search methods: For this update, we searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The most recent searches were conducted in July 2018.

Selection criteria: We considered only randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed-population setting (e.g. community, work-, clinic- or institution-based), and also studies in pregnant smokers.

Data collection and analysis: We used standard Cochrane methods. The primary outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up (at least six months from the start of the intervention). In the trials of pregnant women we used abstinence measured at the longest follow-up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel-Haenzel random-effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster-randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations.

Main results: Thirty-three mixed-population studies met our inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty-four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long-term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease.Although not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self-deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self-deposits.We included 10 studies of 2571 pregnant women. We judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow-up (up to 24 weeks post-partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives.

Authors' conclusions: Overall there is high-certainty evidence that incentives improve smoking cessation rates at long-term follow-up in mixed population studies. The effectiveness of incentives appears to be sustained even when the last follow-up occurs after the withdrawal of incentives. There is also moderate-certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post-partum. Current and future research might explore more precisely differences between trials offering low or high cash incentives and self-incentives (deposits), within a variety of smoking populations.

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Conflict of interest statement

CN: none known. SG: none known. JLB: none known. LB: is co‐author of one of the trials included in the review (Tappin 2015a) and some of the studies cited as supporting evidence in the Background and Discussion sections (Berlin 2018; Hoddinott 2014). RP: none known. JHB: none known.

Figures

1
1
Study flow diagram for 2019 update
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Exploratory meta‐regression testing association between incentive amount and effect estimate
4
4
Funnel plot of comparison: 1 Incentives in mixed populations, outcome: 1.1 Smoking cessation (subgrouped by when incentives were provided).
1.1
1.1. Analysis
Comparison 1 Incentives in mixed populations, Outcome 1 Smoking cessation (subgrouped by when incentives were provided).
1.2
1.2. Analysis
Comparison 1 Incentives in mixed populations, Outcome 2 Smoking cessation (grouped by substance misuse).
2.1
2.1. Analysis
Comparison 2 Incentives in pregnant women, Outcome 1 Smoking cessation at longest follow‐up.
2.2
2.2. Analysis
Comparison 2 Incentives in pregnant women, Outcome 2 Abstinence at end of pregnancy.
2.3
2.3. Analysis
Comparison 2 Incentives in pregnant women, Outcome 3 Contingent rewards vs guaranteed payments.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Tappin 2015a {published data only}
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References to studies excluded from this review

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De Paul 1989 {published data only}
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Dunn 2008 {published data only}
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Dunn 2010 {published data only}
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Gilbert 1999 {published data only}
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Gilbert 2002 {published data only}
    1. Gilbert DG, McClernon FJ, Rabinovich NE, Plath LC, Masson CL, Anderson AE, et al. Mood disturbance fails to resolve across 31 days of cigarette abstinence in women. Journal of Consulting and Clinical Psychology 2002;70(1):142‐52. - PubMed
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    1. Glover M, Kira A, Walker N, Bauld L. Using incentives to encourage smoking abstinence among pregnant indigenous women? a feasibility study. Maternal and Child Health Journal 2015; Vol. 19, issue 6:1393‐9. [DOI: 10.1007/s10995-014-1645-2; ACTRN12614000520639] - DOI - PubMed
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Mooney 2004 {unpublished data only}
    1. Mooney ME. Interventions to increase use of nicotine gum: a randomized, controlled single‐blind trial. Dissertation Abstracts International: Section B: The Sciences and Engineering 2004; Vol. 64:4052.
NCT00508560 {unpublished data only}
    1. NCT00508560. Contingency management for smoking cessation among veterans with schizophrenia or other psychoses. clinicaltrials.gov/ct2/show/NCT00508560 (first received 30th June 2017).
NCT00718835 {unpublished data only}
    1. NCT00718835. Incentive‐based smoking cessation for methadone patients. clinicaltrials.gov/ct2/show/NCT00718835 (first received 21 July 2008).
NCT00807742 {unpublished data only}
    1. NCT00807742. Contingency management for smoking in substance abusers. www.clinicaltrials.gov/ct2/show/NCT00807742 (first received 12th December 2008).
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NCT00960375 {unpublished data only}
    1. NCT00960375. Smoking cessation for veterans with severe and persistent mental illness. www.clinicaltrials.gov/ct2/show/NCT00960375 (first received August 17th 2009).
NCT01040260 {unpublished data only}
    1. NCT01040260. Low‐cost contingency management for smoking cessation. www.clinicaltrials.gov/ct2/show/study/NCT01040260 (first received 29th December 2009).
NCT01145001 {unpublished data only}
    1. Krishnan‐Sarin S. Enhancing a high school‐based smoking cessation program. https://clinicaltrials.gov/ct2/show/NCT01145001 (first received 16th June 2010).
NCT01303081 {unpublished data only}
    1. NCT01303081. Pilot randomized controlled trial of financial incentives for smoking cessation. www.clinicaltrials.gov/ct2/show/NCT01303081 (first received 24th February 2011).
NCT02195570 {unpublished data only}
    1. NCT02195570. Contingency management for smoking cessation in pregnant women. www.clinicaltrials.gov/ct2/show/NCT02195570 (first received 21st July 2014).
Nowicki 1984 {published data only}
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References to studies awaiting assessment

NCT02713594 {published data only}
    1. NCT02713594. Wisconsin tobacco quit line medicaid incentive evaluation. clinicaltrials.gov/show/nct02713594 first received 18 March 2016.

References to ongoing studies

Berlin 2016 {published data only}
    1. Berlin N, Goldzahl L, Jusot F, Berlin I. Protocol for study of financial incentives for smoking cessation in pregnancy (FISCP): randomised, multicentre study. BMJ Open 2016;6(7):e011669. - PMC - PubMed
    1. NCT02606227. Financial incentive for smoking cessation in pregnancy. clinicaltrials.gov/show/nct02606227 (first received 17 November 2015).
Lynagh 2012 {published and unpublished data}
    1. ACTRN12612000399897. ENti‐Ce Project ‐ Encouragement for Nicotine Cessation in pregnant smokers. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347842 (first received 16 March 2012).
    1. Lynagh M, Bonevski B, Sanson‐Fisher R, Symonds I, Scott A, Hall A, et al. An RCT protocol of varying financial incentive amounts for smoking cessation among pregnant women. BMC Public Health 2012;12:1032. - PMC - PubMed
Meyer 2015 {published data only}
    1. Meyer AC, Streck JM, Ochalek TA, Hruska B, Teneback CC, Dixon AE, et al. Financial incentives promote smoking abstinence among patients with pulmonary disease. Drug and Alcohol Dependence 2015;156:e150‐1.
NCT00064922 {unpublished data only}
    1. NCT00064922. Incentive programs for female substance abusers who smoke. clinicaltrials.gov/ct2/show/NCT00064922 (first received 16 July 2003).
NCT00079469 {unpublished data only}
    1. NCT00079469. Bupropion and counseling with or without contingency management to enhance smoking cessation in cancer survivors who continue to smoke. clinicaltrials.gov/ct2/show/NCT00079469 (first received 10 March 2004).
NCT00273793 {unpublished data only}
    1. NCT00273793. Increasing contingency management success using shaping. clinicaltrials.gov/ct2/show/NCT00273793 (first received 9 January 2006).
NCT00408265 {unpublished data only}
    1. NCT00408265. Smoking cessation in substance abuse treatment patients: a feasibility study. clinicaltrials.gov/ct2/show/NCT00408265 (first received 6 December 2006).
NCT00683280 {unpublished data only}
    1. NCT00683280. Contingency management and pharmacotherapy for smoking cessation. www.clinicaltrials.gov/ct2/show/NCT00683280 (first received 23rd May 2008).
NCT00690131 {unpublished data only}
    1. NCT00690131. An integrated approach to smoking cessation in Severe Mental Illness (SMI). clinicaltrials.gov/ct2/show/NCT00690131 (first received 4 June 2008).
NCT01484717 {unpublished data only}
    1. NCT01484717. Interactive Voice Response technology to mobilize contingency management for smoking cessation. www.clinicaltrials.gov/ct2/show/NCT01484717 (first received 2nd December 2011).
NCT01736982 {unpublished data only}
    1. NCT01736982. Contingency management for smoking cessation in the homeless. www.clinicaltrials.gov/ct2/show/NCT01736982 (first received 29th November 2012).
NCT01789710 {unpublished data only}
    1. NCT01789710. Contingency management for smoking cessation in homeless smokers. www.clinicaltrials.gov/ct2/show/NCT01789710 (first received 12th February 2013).
NCT01826331 {published data only}
    1. NCT01826331. Incentives for participation versus outcomes. clinicaltrials.gov/show/nct01826331 (first received 8th April 2013).
NCT01965405 {unpublished data only}
    1. NCT01965405. Smoking cessation for people living with HIV/AIDS. www.clinicaltrials.gov/ct2/show/NCT01965405 (first received 18th October 2013).
NCT02210832 {unpublished data only}
    1. NCT02210832. Financial incentives for smoking cessation among disadvantaged pregnant women. www.clinicaltrials.gov/ct2/show/NCT01526265 (first received 3rd February 2012).
NCT02237898 {unpublished data only}
    1. NCT02237898. Harnessing the power of technology: MOMBA for postpartum smoking. www.clinicaltrials.gov/ct2/show/NCT02237898 (first received September 11th 2014).
NCT02245308 {unpublished data only}
    1. NCT02245308. Abstinence reinforcement therapy (ART) for homeless veteran smokers. www.clinicaltrials.gov/ct2/show/NCT02245308 (first received 19th September 2014).
NCT02266784 {unpublished data only}
    1. NCT02266784. Contingency management, quitting smoking, and ADHD (ADQUIT). www.clinicaltrials.gov/ct2/show/NCT02266784 (first received 17th October 2014).
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References to other published versions of this review

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