Commitment contracts and team incentives: a randomized controlled trial for smoking cessation in Thailand

Area of Science:

• Public Health
• Behavioral Science
• Health Economics

Background:

• Tobacco dependence treatment is scarce in low-resource settings, particularly in developing nations.
• Limited access to smoking cessation interventions hinders public health efforts in rural communities.
• Developing effective and accessible smoking cessation strategies is crucial for global health.

Purpose of the Study:

• To evaluate the effectiveness of a novel intervention using monetary and social incentives for smoking cessation.
• To assess the impact of commitment contracts and team incentives on smoking abstinence in rural Thailand.
• To determine the cost-effectiveness of this intervention compared to existing methods.

Main Methods:

• A randomized controlled trial (RCT) was conducted with 201 adult smokers in rural Thailand.
• Participants were assigned to either a control group receiving counseling or an intervention group receiving counseling plus incentives and reminders.
• Biochemically verified 7-day point prevalence abstinence at 6 months was the primary outcome measure.

Main Results:

• The intervention group achieved significantly higher abstinence rates: 46.2% at 3 months and 44.3% at 6 months, compared to 14.5% and 18.8% in the control group, respectively.
• Adjusted odds ratios indicated a substantial increase in abstinence favoring the intervention group (e.g., 4.2 at 6 months).
• The intervention's incremental cost per quitter was $281, significantly lower than nicotine gum or varenicline in Thailand.

Conclusions:

• The novel incentive-based intervention demonstrated a 91%-136% increase in smoking abstinence at 6 months compared to standard care.
• While treatment effects showed some tapering by 14 months, the intervention remains a promising, cost-effective option.
• This approach offers a viable and economically sound alternative for smoking cessation in resource-limited environments.