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

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Snapshot

Summary of CPSTF Finding

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 CPSTF has related findings for incentives and competitions when used alone (insufficient evidence).

Intervention

Worksite-based incentives and competitions to reduce tobacco use among workers offer rewards to individual workers and to teams as a 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.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement pdf icon [PDF - 152 KB] for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

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What the CPSTF Found

About The Systematic Review

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

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.

Summary of Results

More details about study results are available in the CPSTF Finding and Rationale Statement [PDF - 152 KB].

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

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

Which combinations 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?

Study Characteristics

Interventions that were combined with incentives and competitions included the following:
- 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.

Supporting Materials

Analytic Framework

Effectiveness Review

Analytic Framework pdf icon [PDF 436 KB] - See Figure 1 on page S265

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table -- Effectiveness Review pdf icon [PDF - 244 KB]

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Burling TA, Marotta J, Gonzalez R, et al. Computerized smoking cessation program for the worksite: treatment outcome and feasibility. J Consult Clin Psychol 1989;57(5):619-22.

Glasgow RE, Hollis JF, Ary DV, Boles SM. Results of a year-long incentives-based worksite smoking-cessation program. Addict Behav 1993;18(4):455-64.

Gomel M, Oldenburg B, Simpson JM, Owen N. Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives. Am J Public Health 1993;83(9):1231-8.

Hennrikus DJ, Jeffery RW, Lando HA, et al. The SUCCESS project: the effect of program format and incentives on participation and cessation in worksite smoking cessation programs. Am J Public Health 2002;92(2):274-9.

Jason LA, Jayaraj S, Blitz CC, Michaels MH, Klett LE. Incentives and competition in a worksite smoking cessation intervention. Am J Public Health 1990;80(2):205-6.

Jason LA, Salina D, McMahon SD, Hedeker D, Stockton M. A worksite smoking intervention: a 2 year assessment of groups, incentives and self-help. Health Educ Res 1997;12(1):129-38.

Jeffery RW, Forster JL, French SA, et al. The Healthy Worker Project: a work-site intervention for weight control and smoking cessation. Am J Public Health 1993;83(3):395-401.

Klesges RC, Glasgow RE, Klesges LM. Competition and relapse prevention training in work site smoking modification. Health Educ Res 1987;2:5-14.

Koffman DM, Lee JW, Hopp JW, Emont SL. The impact of including incentives and competition in a workplace smoking cessation program on quit rates. Am J Health Promot 1998;13(2):105-11.

Olsen GW, Lacy SE, Sprafka JM, et al. A 5-year evaluation of a smoking cessation incentive program for chemical employees. Prev Med 1991;20(6):774-84.

Salina D, Jason LA, Hedeker D, et al. A follow-up of a media-based, worksite smoking cessation program. Am J Community Psychol 1994;22(2):257-71.

Windsor RA, Lowe JB. Behavioral impact and cost analysis of a worksite self-help smoking cessation program. Prog Clin Biol Res 1989;293:231-42.

Economic Review

Jason LA, Lesowitz T, Michaels M, et al. A worksite smoking cessation intervention involving the media and incentives. Am J Community Psychol 1989;17(6):785–99.

Jason LA, McMahon SD, Salina D, et al. Assessing a smoking cessation intervention involving groups, incentives, and self-help manuals. Behav Ther 1995;26(3):393–408.

Serxner S, Adams VG, Hundahl LS, Lau S, Adessa CJ Jr, Hopkins D. A smoking cessation pilot program. Hawaii Med J 1993;52(10):266 –72.

Tanaka H, Yamato H, Tanaka T, et al. Effectiveness of a low-intensity intra-worksite intervention on smoking cessation in Japanese employees: a three-year intervention trial. J Occup Health 2006;48(3):175– 82.

Search Strategies

The following outlines the search strategy for incentives and competitions to increase smoking cessation among workers, when used alone or in combination with other interventions.

Effectiveness Review

The articles to be reviewed were obtained from systematic searches of multiple databases, reviews of bibliographic reference lists, and consultations with experts in the field. The following databases were searched for the period January 1980–March 2005: Medline, PsycINFO, EMBASE, and the database of the CDC’s Office on Smoking and Health. The keywords used for the search were health behavior, health education, primary prevention, work, workplace, occupational health, smoke, tobacco, air pollution, indoor, tobacco smoke pollution, smoking cessation, insurance coverage, nicotine dependence treatment, motivation, incentives, compete, competition, and contest. Other relevant sources were identified from the bibliographies of pertinent articles.

Database: Ovid MEDLINE(R)

exp health behavior/ (22792)
exp health education/ (30978)
health promotion/(12410)
exp primary prevention/ (23463)
1 or 2 or 3 or 4 (82228)
exp work/(2185)
workplace/(3661)
occupational health/ (7101)
6 or 7 or 8 (11786)
(smok$ or tobacco).mp. [mp=title, original title, abstract, name of substance, mesh subject heading] (58152)
5 and 9 and 10 (132)
air pollution, indoor/lj (44)
smoking/lj or tobacco smoke pollution/lj (911)
smoking cessation/ and insurance coverage/(27)
smoking cessation/ and nicotine dependence treatment$.mp. [mp=title, original title, abstract, name of substance, mesh subject heading] (12)
12 or 13 or 14 or 15 (977)
11 or 16 (1100)
limit 17 to (english language and yr=2002 - 2004) (315)
limit 18 to "review articles" (38)
from 19 keep 1-38 (38)
21 18 not 19 (277)

Database: EMBASE

(smok$ or tobacco).mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (52779)
Health Behavior/ (6295)
health promotion/ (11391)
health care psychology.mp. or health education/ [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (10276)
prevention/ or health screening/(5934)
2 or 3 or 4 or 5 (30601)
exp occupational health/ (34897)
exp workplace/ (5259)
7 or 8 (37311)
1 and 6 and 9 (220)
indoor air pollution/ and (polic$ or law$ or ordinance$).mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (73)
smoking/ and ((ban$ or restriction$).mp. or pollution/ or passive smoking/) [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (831)
smoking cessation/ and insurance/ (4)
smoking cessation/ and nicotine dependence treatment$.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (18)
11 or 12 or 13 or 14 (920)
10 or 15 (1126)
limit 16 to (english language and yr=2002 - 2004) (412)
limit 17 to "review" (65)
from 18 keep 1-65 (65)
17 not 18 (347)
from 20 keep 1-347 (347)

Database: PsycINFO

health behavior/(2320)
exp health care psychology/(913)
exp health education/(1449)
health promotion/(1688)
exp prevention/(6047)
exp health screening/(1003)
1 or 2 or 3 or 4 or 5 or 6 (11545)
work$.hw. (6748)
7 and 8 (206)
(smok$ or tobacco).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (5334)
9 and 10 (18)
(indoor air and (polic$ or law$ or ordinance$)).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (4)
tobacco smoking/and (ban$ or restriction$).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (121)
(second-hand smoke or passive smoking).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (37)
smoking cessation/and health insurance/(5)
smoking cessation/and nicotine dependence treatment$.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (2)
12 or 13 or 14 or 15 or 16 (162)
11 or 17 (180)
limit 18 to (english language and yr=2002 - 2004) (123)
20 limit 19 to "1300 literature review" (8)
from 20 keep 1-8 (8)
19 not 20 (115)
from 22 keep 1-115 (115)

CDP Search Criteria- Smoking and Health Database

Descriptors: ("health behaviors" or "health education" or "health promotion" or "prevention of smoking") and (work*) and
(smok* or tobacco*) and
Publication Year: 2002 To 2004

Descriptors: "indoor air pollution" or "tobacco pollution" and
Textwords: polic* or law* or ordinance* and
Publication Year: 2002 To 2004

Descriptors: "smoking cessation" and
Textwords: insurance or nicotine adj dependence adj treatment* and
Publication Year: 2002 To 2004

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

Implementers should understand state policies regarding application of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to the use of economic incentives in the workplace.
The logistics of verifying smoking cessation may present additional costs.

Crosswalks

Healthy People 2020

Healthy People 2020 includes the following objectives related to this CPSTF recommendation.

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

Tabs

Summary of CPSTF Finding

Intervention

CPSTF Finding and Rationale Statement

Users who viewed this also viewed

About The Systematic Review

Summary of Results

Summary of Economic Evidence

Applicability

Evidence Gaps

Study Characteristics

Analytic Framework

Effectiveness Review

Summary Evidence Table

Effectiveness Review

Included Studies

Effectiveness Review

Economic Review

Search Strategies

Effectiveness Review

Database: Ovid MEDLINE(R)

Database: EMBASE

Database: PsycINFO

CDP Search Criteria- Smoking and Health Database

Considerations for Implementation

Crosswalks

Healthy People 2020

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