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Contests To Quit Smoking Don't Work In Long Run

Ruzanna Harutyunyan's picture

Face it: we all have our price. Still, despite prizes ranging from lottery tickets to cash payments, quit-smoking contests do not help people kick the habit in the end, according to a new systematic review of studies.

None of the 17 studies, which involved roughly 6,300 participants, demonstrated significantly higher long-term quit rates for smokers offered incentives, despite some creative approaches.

In one study, participants were encouraged to toss their cigarettes down the toilet and rewarded with one lottery ticket per day. Another offered payments of $10 per month and participation in a monthly worksite lottery. Yet another offered cash prizes ranging from $100 to $250, along with certificates of recognition.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Studies occurred in the United States, Canada, the United Kingdom and Australia. Workplaces and clinics were common settings for the competitions.

“In my view, none of them was effective,” said review co-author Kate Cahill at the University of Oxford. “One of our main conclusions was that if incentives work at all, they only work while they’re in place; if you revisit those quitters 12 or 24 months down the line, they [smokers offered incentives] were generally no more successful” than counterparts not offered incentives.

One-year cessation rates for participants in one study were 22 percent — more than double that of those not offered incentives. However, by the one-year evaluation, the quit rate for participants was much closer to that of non-participants. In addition, the difference between participants and the group not offered incentives “had become non-significant at the two-year follow up,” the reviewers found.

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Offering incentives is a tricky business. “An effective incentive should be large enough to attract smokers motivated to try and quit, but not so attractive that the desire to win outweighs the seriousness of the quit attempt,” the reviewers say.

In a 1994 paper, which was not part of the Cochrane review, an Australian researcher described how one smoking-cessation competition offered a $30,000 car as a grand prize.

By polling entrants after the contest, researchers “found that 34 percent were either ex-smokers or never-smokers who had entered the contest solely in order to win the prize, confident that they could confirm their smoke-free status with a breath sample.” Cahill recalled. “I think it’s a perfectly valid approach to reward people for entering a smoking cessation program … but the risk of deception rises with the scale of the cessation rewards.”

In a landmark announcement in 1964, the U.S. Surgeon General linked smoking and cancer. Census records show that as of the next year, 42 percent of all adults were “current” smokers. By 2006, after years of public awareness and education campaigns, roughly 21 percent identified themselves as current smokers. That dramatic decrease will be counted as one of the public health successes of the 20th century, said Michael Fiore, director of the University of Wisconsin Center for Tobacco Research and Interventions.

However, the pool of smokers — including younger people — is dynamic and health officials still struggle to eliminate tobacco use with limited resources. Fiore said that the cessation contests in the review clearly did not offer a big bang for the buck. However, he added, “Maybe some of these programs have collateral benefit, in that they encourage people – who may not have thought about quitting – to quit.”

There is no one unequivocal way to eliminate all tobacco use. Efforts hinge on prescription drug treatments, counseling and 1-800-QuitNow telephone lines. “Smokers are extraordinarily diverse as individuals,” Fiore said. “There is never going to be a one size fits all.”

If it were easy, it would have happened by now, researchers say. “We have an enormous number quitting every year. There are not a lot of smokers who say ‘I smoke and I love it,’” Fiore said. It is more common, he said, to encounter smokers who feel ‘hooked,’ who feel trapped by a disease, who feel discouraged in dealing with a powerful drug of dependence.”

Public health officials continue a barrage of efforts — including contests. Earlier this summer, a Scottish Health Board announced a three-month incentive plan in Dundee, Cahill said. Smokers who pass a weekly breath test will get the equivalent of about $24 each time in the form of grocery credit. Winners cannot use the money for alcohol or tobacco.