A daily lottery ticket? $580 in cash? Entry in a $3,960 sweepstakes? Would any of these prizes be enough to get you to quit smoking?
Researchers have explored whether incentives can help people change their habits since they started enticing preschoolers to draw more by rewarding them with ribbons and gold seals in the early 1970s.
But a new systematic review of 56 anti-smoking experiments conducted over three decades in the U.S., U.K., Canada and Australia found that, in the end, competitions and incentives don’t lead to long-term success.
“It sounds so plausible; it seems like it should work. But in the cold light of day…the quit rate just doesn’t change,” says Oxford University’s Dr. Kate Cahill, co-author of the Cochrane Collaborations new review, “Competitions and Incentives for Smoking Cessation.”
Cahill and her co-author concluded that only 17 of the studies met the key threshold of sustained success after six months. And, in those studies, people who received cash or other prizes quit at rates no higher than for members of the control group.
What’s more, they found that the kind of reward offered—whether it was a cash or salary bonus, vacations or promotional T-shirt—didn’t make much of a difference. Nor did the setting of the studies, which included work sites, health care centers and community groups.
Whether it’s intended to curb smoking, stimulate education or attract more people to cancer screenings, researchers across disciplines have long been divided over whether rewards and competition are good practice.
“From a psychological standpoint, there are potential problems with incentives,” says Dr. Joel Moskowitz of the University of California-Berkeley’s School of Public Health. “For one, people are likely to falsify something if they’re doing it for money.”
In the case of anti-smoking programs, it might mean that smokers try to fool researchers into believing they’ve quit when they haven’t. Or it could be non-smokers hoping to score a buck by feigning addiction.
Researchers also struggle with a concept known as “oversufficient justification,” in which big payoffs can lessen people’s appreciation for the task at hand.
“There’s this notion of intrinsic and extrinsic motivation. You want people to do something to please themselves rather than please someone else,” Moskowitz explains.
This may lead some smokers to sign up who need the money but don’t have a sincere desire to quit smoking. Such participants might breeze through their treatment programs without giving it their full commitment—for example, rushing through literature on a Web site. That behavior is unlikely to lead to success.
However, experts don’t think it’s time to give up on rewards. Cahill favors using incentives to get more people signed up for anti-smoking programs by offering rewards to all participants, rather than just successful quitters, because “then you’d get a boost in your absolute numbers.”
The best approach may be to use incentives to lure smokers to cessation programs that researchers like Moskowitz already believe work: those that combine drug therapy with cognitive behavorial programs designed to give smokers the tools to just say no.
Moskowitz believes that rewards have to be carefully tailored to suit their target population. In a cervical cancer screening drive he led in one community, offering donations to local churches didn’t work, whereas giving out direct gift vouchers for a grocery store did. In contrast, in wealthier communities, people might be willing to stop smoking in return for support of a good cause.
He also cautioned that one limitation of the review is that many of the studies examined used relatively small sample groups, some with fewer than 100 participants. Moskowitz worries that small group studies lack statistical power.
For example, Moskowitz is currently helping to conduct an anti-smoking study that uses two groups with 600 participants in each. In his view, to use 60 would be “pointless.”
“If you want to have an impact at a population level,” he says, “you have to recruit much bigger numbers.”