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Tobacco Use and Secondhand Smoke Exposure: Incentives and Competitions to Increase Smoking Cessation Among Workers – When Combined With Additional Interventions

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 12 studies (search period January 1980 - March 2005).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.

Context

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Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 152 kB].

The systematic review included 12 studies.

  • One group randomized trial found a reduction in self-reported tobacco use of 2.1 percentage points (p=0.03) among workers from 32 worksites that offered smoking cessation programs and self-imposed payroll withholdings.
  • Tobacco quit rates increased by a median of 4.3 percentage points (14 study arms in 11 studies).
    • Program participants achieved a median quit rate of 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.
    • Program participants achieved a median quit rate of 21%.
    • The median period of follow-up was 12 months.

Summary of Economic Evidence

A review of economic evidence found inconsistencies in study designs making it difficult to draw conclusions about potential cost savings.

Applicability

Findings from this review should be applicable to U.S. worksites where there are more than 100 employees. Studies included in this review were done in urban and suburban areas in the United States and comprised manufacturing plants, healthcare facilities, government offices, a university, chemical plants, and an ambulance service.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • Which combinations of incentives and rewards are most effective?
  • What are short and long term cessation rates for tobacco users based on the inclusion or absence of an incentive or competition?
  • What would be the effect of giving workers access to nicotine replacement therapies (and other effective pharmacotherapies), as part of a combined cessation program?
  • What are program participation rates?

Study Characteristics

  • Interventions that were combined with incentives and competitions included the following:
    • 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
    • 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.

Publications