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

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends worksite-based incentives and competitions when combined with additional interventions to support individual cessation efforts and reduce tobacco use among workers.

The full CPSTF Finding and Rationale Statement and supporting documents for Tobacco Use: Incentives and Competitions to Increase Smoking Cessation Among Workers – When Combined With Additional Interventions are available in The Community Guide Collection on CDC Stacks.

Intervention

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

  • 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, or return of self-imposed payroll withholdings

About The Systematic Review

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

Study Characteristics

  • 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: 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.

Summary of Results

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

  • Which combination 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?

Implementation Considerations and Resources

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.