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

Research Gap

What are Research Gaps?

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as "research gaps." Research gaps can be pulled together in the form of a basic set of questions to inform a research agenda for those in the field or can be a more extensive narrative that weaves mention of gaps into a discussion generated by findings from the review.

Incentives and Competitions When Used Alone

Only a single study of worksite-based incentives or competitions when implemented alone was identified, thus there was an insufficient number of studies to draw a conclusion on the evidence on effectiveness. Consequently, this intervention approach remains a potential area for future research. An earlier Community Guide review of community-based smoking cessation contests also found insufficient evidence to support a conclusion on effectiveness. In the community-based intervention studies, evidence was considered insufficient because most studies focused only on contest participants and did not include either a defined study population of eligible tobacco users or a concurrent comparison group. Worksite-based interventions, in contrast to community-based efforts, provide a study population that may be easier to quantify and define, and should provide an opportunity to evaluate participation and impact among eligible tobacco users. In addition, incentives might be offered in ways other than through tobacco cessation contests (such as rewards for setting and achieving personal health goals) and these intervention options remain an area for further research.

Incentives and Competitions When Combined with Additional Interventions

Although the evidence demonstrates that worksite-based smoking cessation interventions, when implemented in combination with incentives and competitions, are effective, the studies evaluated in this review do not provide sufficient evidence to distinguish the independent or synergistic contribution of rewards on participation or tobacco use behavior change. Future studies, for example, could directly compare short and long term cessation rates for tobacco users recruited to a worksite-based group cessation program based on the provision or absence of an incentive or competition.

Only one study specifically included or evaluated access to nicotine replacement therapies as part of a worksite cessation program. Worksite-based interventions to increase access to nicotine replacement therapies (and other effective pharmacotherapies), as part of a combined cessation program, remain an area for further research.

We observed, as also described in other reviews, recurring problems in the measurement and reporting of tobacco use outcomes. Future research needs to address these problems. Analyses that include the entire workforce or an estimate of the proportion of tobacco users from a baseline survey of self-reported smoking status (i.e., those eligible for this intervention) would permit calculations of program participation and estimates of intervention impact (such as a change in workforce tobacco use prevalence or in the total number of current tobacco users). In several studies, follow-up periods were calculated from the initiation of the intervention and not from the end of the intervention (e.g., from the last round of a smoking cessation contest).