Decreasing Tobacco Use in Worksite Settings: Incentives and Competitions to Increase Smoking Cessation Among Workers

Worksite-based incentives and competitions to reduce tobacco use among workers offer rewards to individual workers and to teams as a motivation to participate in a cessation program or effort.

• Rewards can be provided for participation, for success in achieving a specified behavior change, or for both.
• Types of rewards may include guaranteed financial payments, lottery chances for monetary or other prizes, and return of self-imposed payroll withholdings.

Task Force Recommendations & Findings

The Task Force on Community Preventive Services found insufficient evidence to determine whether or not worksite-based incentives and competitions alone work to reduce tobacco use among workers. Evidence was considered insufficient because only one study of least suitable design was identified in this review.

The Task Force recommends worksite-based incentives and competitions when combined with additional interventions to support individual cessation efforts based on sufficient evidence of effectiveness in reducing tobacco use among workers.

Task Force findings and rationale statement

Results from the Systematic Reviews

Worksite-based Incentive Programs when Implemented Alone to Reduce Tobacco Use among Workers

• Only one study qualified for this review so conclusions could not be drawn.

Worksite-based Incentives and Competitions When Combined with Additional Interventions to Reduce Tobacco Use among Workers

• Twelve studies qualified for the review.
• One group randomized trial of 32 worksites found a reduction in self-reported tobacco use of 2.1 percentage points (p=0.03) among workers in worksites with a smoking cessation program and self-imposed payroll withholdings.
• Tobacco quit rates: median increase of 4.3 percentage points (interquartile interval: 2.7 to 8.0 percentage points; 14 study arms in 11 studies).
  • The median quit rate achieved by program participants was 15%.
  • The median period of follow-up was 12 months.
• A subset of five studies evaluated a similar combination of interventions (including at a minimum, an incentive, a worksite-based tobacco cessation group, and educational materials or activities). In these studies, tobacco quit rates increased by a median of 10 percentage points.
  • The median quit rate achieved by program participants was 21%.
  • The median period of follow-up was 12 months.
  • Interventions that were combined with incentives and competitions included:
    • Client education
    • Smoking cessation groups
    • Self-help cessation materials
    • Telephone cessation support
    • Workplace smoke-free policies
    • Social support networks.
• Individual rewards ranged from $10 to $237.
• Lottery prizes ranged from $40 to $500.
• Studies included in this review were conducted in the United States in:
  • Manufacturing plants, healthcare facilities, government offices, a university, chemical plants, and an ambulance service
  • Companies or worksites with more than 100 employees
  • Urban and suburban settings
• The presence of an incentive or competition was not associated with a consistent increase in participation in worksite tobacco programs in the studies considered in this review; however participation rates were high in most of the intervention and comparison study arms.
• A review of the economic effectiveness of this intervention was conducted. Due to inconsistencies in study designs strong conclusions about cost savings cannot be substantiated.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to worksite health promotion and the prevention of tobacco use.

Supporting Materials

• Research gaps
• Included studies
  • Incentives and Competitions When Used Alone
  • Incentives and Competitions When Combined with Additional Interventions
• Search strategy

Publications

More Community Guide publications about Tobacco

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Disclaimer

The findings and conclusions in this page are those of the authors and the Task Force on Community Preventive Services and do not necessarily represent the official position of CDC.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Decreasing tobacco use in worksite settings: incentives and competitions to increase smoking cessation among workers. www.thecommunityguide.org/tobacco/worksite/incentives.html. Last updated: MM/DD/YYYY.

Review completed: 2000