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Area of Science:

  • Public Health
  • Behavioral Science
  • Addiction Medicine

Background:

  • Financial incentives, such as money, vouchers, or self-deposits, are utilized to reinforce smoking cessation.
  • These incentives can be delivered as one-off rewards or through contingency management schedules for sustained abstinence.
  • Incentive programs have been implemented across diverse settings including workplaces, clinics, and community-based initiatives.

Purpose of the Study:

  • To evaluate the long-term efficacy of financial incentives and contingency management programs for smoking cessation in mixed and pregnant populations.
  • To assess the sustained effects of incentives beyond the intervention period.
  • To analyze outcomes specifically for pregnant populations, differentiating between contingent and guaranteed rewards.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) identified through comprehensive database searches.
  • Inclusion criteria encompassed studies in mixed populations (community, work, clinic-based) and pregnant individuals who smoke.
  • Primary outcome was smoking abstinence at longest follow-up (≥6 months for mixed, ≥ end of pregnancy for pregnant populations); data pooled using random-effects models.

Main Results:

  • Forty-eight mixed-population studies (21,924 participants) showed a pooled risk ratio (RR) of 1.52 (95% CI 1.33 to 1.74) for smoking cessation with incentives.
  • Incentive effectiveness was sustained at long-term follow-up, even after withdrawal of rewards (RR 1.46, 95% CI 1.23 to 1.73).
  • Fourteen studies (4314 participants) involving pregnant individuals demonstrated a pooled RR of 2.13 (95% CI 1.58 to 2.86) for cessation.

Conclusions:

  • High-certainty evidence confirms that financial incentives significantly improve long-term smoking cessation rates in mixed populations.
  • Incentive schemes are highly effective for smoking cessation among pregnant individuals, with high-certainty evidence now established.
  • Future research should explore incentive effectiveness across diverse populations, particularly in low- and middle-income countries.