Abstract
Introduction We evaluate whether a combination of financial incentives and deposit contracts improves cessation rates among low- to moderate-income smokers. Methods We randomly assigned 311 smokers covered by Medicaid at 12 health clinics in Connecticut to usual care or one of the three treatment arms. Each treatment arm received financial incentives for two months and either (i) nothing further (“incentives only”), (ii) the option to start a deposit contract with incentive earnings after the incentives ended (“commitment”), or (iii) the option to precommit any earned incentives into a deposit contract starting after the incentives ended (“precommitment”). Smoking cessation was confirmed biochemically at two, six, and twelve months. Results At two, six, and twelve months after baseline, our estimated treatment effects on cessation are positive but imprecise, with confidence intervals containing effect sizes estimated by prior studies of financial incentives alone and deposit contracts alone. At two months, the odds ratio for quitting was 1.4 in the incentive-only condition (95% CI: 0.5 to 3.5), 2.0 for incentives followed by commitment (95% CI: 0.6 to 6.1), and 1.9 for incentives and precommitment (95% CI: 0.7 to 5.3). Conclusions A combined incentive and deposit contract program for Medicaid enrollees, with incentives offering up to $300 for smoking cessation and use of support services, produced a positive but imprecisely estimated effect on biochemically verified cessation relative to usual care and with no detectable difference in cessation rates between the different treatment arms.
Highlights
We evaluate whether a combination of financial incentives and deposit contracts improves cessation rates among lowto moderate-income smokers
18-65-year-old respondents to the 2015 National Health Interview Survey shows chronic obstructive pulmonary disease (COPD) rates of 6.2% among Medicaid enrollees compared to 1.2% for privately insured respondents
Our hypothesis was that financial incentives would increase cessation rates for all treatment groups relative to usual care in the short term, i.e., when measured at two months
Summary
Smoking rates have declined dramatically in the United States but remain high in the Medicaid population [1, 2]. Medicaid enrollees are less likely to use formal cessation services in quit attempts and are less successful in quitting when they try (HHS, 2018; [1, 3,4,5,6]) This population continues to suffer from high rates of chronic smoking-related diseases [7] For example, nationally representative data on. Whereby participants forfeit their own money if a cessation target is not met, are effective on average. Our hypothesis was that financial incentives would increase cessation rates for all treatment groups relative to usual care in the short term, i.e., when measured at two months. Our third hypothesis was that deposit contract take-up would be higher in the precommitment arm than in the commitment arm
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