Financial Incentives for Smoking Cessation

Overseen By Kimberly S Cherewick

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Georgia

Must be taking: Nicotine replacement

Disqualifiers: Psychosis, E-cigarettes, Heart disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 5

Duration: 6 months

900 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to help dual-smoker couples quit smoking by testing financial incentives as a motivator. Participants will be divided into three groups: one will receive standard care, the second will offer incentives to one partner, and the third will offer incentives to both partners. The goal is to determine which approach most effectively helps couples quit smoking for the long term. Couples qualify if both smoke at least 5 cigarettes a day, have been in a relationship for at least six months, and live together. The study will also evaluate the cost-effectiveness of each method.

As an unphased trial, this study provides couples with a unique opportunity to explore innovative methods to quit smoking together.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you will receive usual care, which includes Nicotine Replacement Therapy, so it's best to discuss with the trial team if you have concerns about your current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Past studies have shown that offering money helps people quit smoking. Research indicates that smokers are more likely to quit when they receive financial rewards. In one study, about 19.6% of those who received money stopped smoking, compared to 8.9% of those who did not.

For the Dyadic Financial Incentive Treatment (DFIT), which involves both partners in a smoking couple, studies suggest that rewarding both partners can boost their motivation and success in quitting. This method has been explored as a way to help couples quit smoking together.

Participants generally find these programs satisfying and motivating. Reports of negative effects from these financial incentive programs have been minimal, suggesting they are well-tolerated. Since this trial does not involve a new drug or medical treatment, the risk of physical side effects is low. Instead, it focuses on changing behavior using financial motivation as the main tool. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these financial incentive treatments for smoking cessation because they offer a fresh approach compared to traditional methods like nicotine replacement therapy or prescription medications. Unlike these standard treatments, the Single-Target Financial Incentive Treatment (SFIT) provides financial rewards to one partner in a couple who achieves smoking abstinence, adding a motivational twist. The Dyadic-FIT condition (DFIT) takes it a step further by involving both partners, potentially doubling the motivation with twice the financial incentives. This unique approach not only targets individual behavior but also leverages the dynamics of relationships to encourage quitting smoking in a supportive environment.

What evidence suggests that this trial's financial incentive treatments could be effective for smoking cessation in dual-smoker couples?

Studies have shown that financial incentives can help people quit smoking and remain smoke-free over time. In this trial, participants may be assigned to the Single-Target Financial Incentive Treatment (SFIT). Research has shown that rewarding one member of a couple financially can increase their chances of quitting smoking successfully, even after the rewards end. Alternatively, participants might be assigned to the Dyadic Financial Incentive Treatment (DFIT), which provides incentives to both partners in a couple. This approach effectively boosts quit rates, as both partners support each other, and the added motivation of financial rewards can be more powerful than quitting alone. Overall, these treatments have demonstrated promising results in helping people quit smoking and maintain their progress. ^{1 2 3 4 5}

Who Is on the Research Team?

Michelle R vanDellen, PhD

Principal Investigator

University of Georgia

Are You a Good Fit for This Trial?

This trial is for couples where both partners smoke cigarettes. They must be willing to try quitting together and participate in a study that involves financial incentives as motivation. Specific eligibility details are not provided, but typically participants would need to meet certain health criteria and commit to the study's schedule.

Inclusion Criteria

Romantic relationship duration of at least six months

Smoking of 5+ cigarettes/day

I am married to or live with someone over 18 who smokes more than 5 cigarettes daily.

Exclusion Criteria

Marijuana use

Less than 8th grade capacity to read and write in English

Psychosis risk

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline

Participants complete a baseline session and are offered quitting resources

1 session

1 visit (remote video conference)

Treatment

Participants receive financial incentives for abstinence at 1, 3, and 6 months post-baseline

6 months

3 visits (remote video conference)

Follow-up

Participants are monitored for long-term abstinence and smoking behavior

6 months

1 visit (remote video conference)

What Are the Treatments Tested in This Trial?

Interventions

• Financial Incentive Treatment (FIT)

Trial Overview The trial tests two versions of Financial Incentive Treatments (FITs) designed to help dual-smoker couples quit smoking. Participants will receive usual care plus potential cash rewards for abstaining from smoking at set intervals. One group gets incentives just for one partner, while the other group has both partners receiving incentives.

How Is the Trial Designed?

Group I: Single-Target FIT (SFIT) Experimental Treatment 1 Intervention

One couple member offered incentives. Targets in the SFIT condition will be offered financial incentives for biochemically verified abstinence ($200 at each of three follow-ups \[1, 3, and 6 Month\]).

Group II: Dyadic-FIT condition (DFIT) Experimental Treatment 1 Intervention

Both couple members offered incentives and tracked across 12 months. Both targets and partners will be offered financial incentives for abstinence. Thus, in this condition, the total financial incentives offered to the dyad are twice the amount as offered to participants in the SFIT condition.

Group III: No-FIT Treatment-as-Usual (TAU) Condition Active Control 1 Intervention

Participants in the no-FIT control condition will not receive incentives.

Financial Incentive Treatment (FIT) is already approved in United States, European Union for the following indications:

Approved in United States as Financial Incentive Treatment for:

• Smoking cessation

Approved in European Union as Financial Incentive Treatment for:

• Smoking cessation

Who Is Running the Clinical Trial?

University of Georgia

Lead Sponsor

Trials

109

Recruited

43,500+

McMaster University

Collaborator

Trials

936

Recruited

2,630,000+

University of Kentucky

Collaborator

Trials

198

Recruited

224,000+

Published Research Related to This Trial

The FIESTA II study is a randomized controlled trial designed to evaluate the effectiveness of financial incentives in promoting smoking cessation among hospitalized smokers, with participants recruited from underserved communities in New York City and Los Angeles.

Participants will be divided into three groups: one receiving goal-directed financial incentives, another receiving outcome-based incentives, and a control group receiving standard care, with the potential to earn significant rewards for completing follow-up interviews and achieving smoking cessation milestones.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Goal-directed versus outcome-based financial incentives for smoking cessation among low-income, hospitalised patients: rationale and design of the Financial Incentives for Smoking Treatment II (FIESTA II) randomised controlled trial. Wali, S., Gaitonde, A., Sherman, S., et al.[2023]

In a study involving 239 pregnant smokers in England, financial incentives for quitting smoking led to a 20% cessation rate at delivery and a 10% cessation rate at 6 months postpartum, indicating prolonged effectiveness similar to previous US trials.

The study found minimal evidence of 'gaming' or false reporting among participants, with only 4% of enrolled women attempting to misreport their smoking status to gain incentives, suggesting that financial incentive schemes can be implemented with integrity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Financial incentives for smoking cessation in pregnancy: a single-arm intervention study assessing cessation and gaming. Ierfino, D., Mantzari, E., Hirst, J., et al.[2022]

A study involving 3,816 Medicaid beneficiaries found that modest financial incentives significantly improved smoking cessation outcomes, including quit attempts and abstinence rates, compared to usual care.

Participants receiving nicotine patches along with financial incentives were more likely to achieve both short-term (7-day and 30-day) and long-term (6-month) abstinence, demonstrating the effectiveness of integrating financial incentives into smoking cessation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Incentives and Patches for Medicaid Smokers: An RCT. Anderson, CM., Cummins, SE., Kohatsu, ND., et al.[2019]

A study involving 604 smokers from 61 companies in the Netherlands found that financial incentives combined with a smoking cessation group training program significantly increased the 12-month abstinence rates, with 41% of participants in the incentive group remaining smoke-free compared to 26% in the control group.

The adjusted odds ratio of 1.93 indicates that participants receiving financial incentives were nearly twice as likely to quit smoking successfully, suggesting that such incentives could be an effective strategy for workplace smoking cessation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of a workplace-based group training programme combined with financial incentives on smoking cessation: a cluster-randomised controlled trial. van den Brand, FA., Nagelhout, GE., Winkens, B., et al.[2019]

A review of 26 studies on financial incentive programs for smoking cessation found that higher incentive amounts did not correlate with higher quit rates, suggesting that simply increasing financial rewards may not be effective in promoting smoking cessation.

The study highlighted the need for further research to determine optimal financial incentive amounts and their cost-effectiveness, as current evidence is insufficient to draw definitive conclusions due to variations in study designs and populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Higher incentive amounts do not appear to be associated with greater quit rates in financial incentive programmes for smoking cessation. Breen, RJ., Ferguson, SG., Palmer, MA.[2021]

Financial incentives for healthcare professionals can enhance the recording of patients' smoking status and increase the provision of smoking cessation advice, as shown in a systematic review of 18 studies.

However, the evidence is mixed regarding whether these financial incentives actually lead to significant reductions in smoking rates or improved long-term abstinence, indicating that more research is needed in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of providing financial incentives to healthcare professionals for smoking cessation activities: systematic review. Hamilton, FL., Greaves, F., Majeed, A., et al.[2018]

Only 38.4% of smokers supported financial incentives for smoking cessation, with support being higher among heavy smokers and those who recently attempted to quit, indicating a need for better education on the effectiveness of such schemes.

Concerns about personal responsibility, potential abuse of the system, and fairness were major reasons for opposition to financial incentives, suggesting that addressing these issues through media advocacy could increase acceptance and implementation of these programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perceptions of Financial Incentives for Smoking Cessation: A Survey of Smokers in a Country With an Endgame Goal. Robertson, L., Gendall, P., Hoek, J., et al.[2019]

In a study involving 179 smokers, modest financial incentives significantly increased enrollment (43.3% vs. 20.2%) and completion (25.8% vs. 12.2%) of a smoking cessation program, indicating that financial rewards can effectively motivate participation in such programs.

The incentive group achieved a higher short-term quit rate at 75 days (16.3% vs. 4.6%), but this difference was not maintained at 6 months, suggesting that while incentives can boost initial success, additional strategies may be needed for long-term cessation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of financial incentives for smoking cessation. Volpp, KG., Gurmankin Levy, A., Asch, DA., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11220567/

Financial Incentives for Smoking Cessation Among ... This randomized clinical trial compares the long-term effects of adjunctive, low-cost financial incentives plus usual care for smoking cessation.

2. research.uga.edu research.uga.edu/research-insights/randomized-controlled-trial-of-dyadic-financial-incentive-treatment-for-dual-smoker-couples-evaluation-of-efficacy-mechanisms-and-cost-effectiveness-michelle-vandellen/

Randomized Controlled Trial of Dyadic Financial Incentive ... Building on previous research that suggests a) financial incentive treatments (FITs) are effective at increasing quit rates; and b) dyadic ...

3. trialx.com trialx.com/clinical-trials/listings/285397/dyadic-financial-incentive-treatments-for-dual-smoker-couples/?&radius=10&place=Putzu&user_country=Taiwan

Dyadic Financial Incentive Treatments for Dual Smoker ... Primary efficacy outcome is % point-prevalence abstinence at 6 months post-baseline among targets. Secondary outcomes are point-prevalence ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT03979885

NCT03979885 | Financial Incentives for Smoking Treatment II The investigators will pursue two specific aims: 1) comparing the impact of three approaches for smoking cessation on smoking abstinence, use of evidenced-based ...

5. reporter.nih.gov reporter.nih.gov/project-details/10056718

Testing Financial Incentive Interventions in Dyadic-Smoker ... Building on previous research that suggests financial incentive treatments (FITs) are effective at increasing motivation to quit and quit rates ...