Financial incentives to ban

smoking

Facts
#1 preventable cause of death in US, killing over 393,000
people each year.1
Second hand smoking leads to 50,000 deaths each year.
Total annual public and private health care costs for the
nation due to smoking is $96 billion.
Highest cigarette tax in the country is $3.46 per pack
(Rhode Island) and the lowest is 7 cents (South Carolina)
Alabamas cigarette tax is 42.5 cents per pack (ranked
45th in the country).8

Measures to eradicate smoking in

Alabama
Ban on smoking in public places and demarcated areas.
Penalty to minors for use, possession and transportation
of tobacco products and to those who sell tobacco
products to minors.
Restrictions to sale of tobacco products through vending
machines.
Higher taxes on tobacco products to deter their sales and
stricter license rules for vendors and dealers.
Surprisingly Alabama is amongst the 5 states that does
not offer any help for quitting smoking on Medicaid.2

Benefits of ban on smoking

Decrease in the incidence of cardiovascular and
coronary artery disease from anywhere between 6 to
47 %.3
Contrary to previous beliefs, the businesses like
restaurants, theatres etc benefited from the ban
since more non-smoking people started visiting these
places.
Employers can afford to give incentives rather than
pay the inflated premiums incurred due to health
care costs of smokers.

Factors against the ban.

Fear of loss of employment and businesses like
bowling alleys, pubs, casinos which are affected
by bans.9
Infringes on right to personal choice of life style.
Not adequate government will power to
implement harsh laws banning tobacco products.
People find costs of nicotine patches more than a
pack of cigarette.

Current status
Only 57.8% of the smokers in Alabama have
attempted to quit smoking which is marginally
less than nations rate at 58.2%.4
25.2% males in Alabama smoke while 19.3%
females smoke compared to 20.7% males and
16.2% females smoking in entire US.
There is no statewide ban on smoking,
compared to other states.

New approach: Financial incentives

Positively reinforcing measures like cash rewards
or vouchers at workplaces for those who enroll
for smoking related health programs that help to
quit smoking.
Bonuses for those who have abstained from
smoking over a long period of time.
Lowering of premiums for insurances for those
who do not smoke or have quit smoking.
Negative reinforcements by not giving any perks
if failing to quit smoking or stay non smoker.

What does data really say?

Incentives increased the participation by
smokers but it did not enhance the long term
quit rates beyond 6 months.5
Incentives made people aware and prompted
them to use self help materials and quit for a
shorter time, but it did not improve the
number of people who succeeded in quitting
smoking entirely.

What does data really say? contd.

Compliance among smokers to quit smoking is
good during the study duration, but it is no
better than the unassisted participants after
the incentives are stopped.
Use of self help manuals, skill training, social
enhancement and incentives over a period of
12 months at a worksite showed that
incentives not only didnt help but reduced
the effectiveness of other strategies.

Recent evidence.7
A study conducted by University of
Pennsylvania, school of medicine involved
employees of GE company.
It was an RCT with sample size of 878
employees and published in NEJM in 2009.
One group (case) was given counseling and
incentives of $750 while the other group
(control) was just given counseling to quit
smoking.

Results of the study.

Although incentives tripled cessation rates,
quitters did not necessarily perceive
incentives to be helpful.
Generally, quitters were already motivated to
quit and would have quit for less money.
Non-quitters gave large range of estimates for
optimal incentive amount needed to quit.
Incentives may not be a feasible intervention
strategy for all smokers.

Recommendation
State of Alabama should contribute to the medicaid
premiums for the health care costs for quitting
smoking.
Financial incentives should be targeted at population
for whom they may be more effective.
More research is needed to understand how to
optimize incentive amount, incentive structure and the
cost benefit to employers.
Additional research is needed on the comparative
effectiveness of incentives relative to other cessation
interventions such as nicotine replacement therapy.

References.
1.
2.
3.
4.
5.
6.
7.

http://www.stateoftobaccocontrol.org/2009/facts/
http://slati.lungusa.org/reports/SmokefreeStates01-10.pdf
http://slati.lungusa.org/state-teml.asp?id=1
http://www.statehealthfacts.org/comparetable.jsp?ind=85&cat=2
http://www.alacc.org/Smoking%20Cessation.htm
www.rti.org
Volpp K, Troxel A. A Randomized, Controlled Trial of Financial incentives
for Smoking Cessation. NEJM. 2009;360:699-709.
8. http://blog.al.com/livingnews/2009/06/alabama_stays_on_low_end_of_ta.html
9. http://www.freewebs.com/jainsudhir/smokingvsemployment.htm
10. http://www.webmd.com/smoking-cessation/news/20090210/financialincentives-help-smokers-quit

Questions.