Paying employees to quit smoking pays off

Making a meaningful contribution to people’s health is what drives researchers at the research school CAPHRI at Maastricht University. But it usually takes some time for research to have a real-world effect. Two CAPHRI studies on smoking cessation are an exception to this rule. Dr Floor van den Brand and Professor Gera Nagelhout are carrying out projects with a direct, positive impact on people’s health. Below, the researchers talk about their successful project on the effect of employers providing financial incentives to help their employees quit smoking and its follow-up implementation project.

“Twenty per cent of all people in the Netherlands smoke”, says Floor van den Brand, a postdoctoral researcher at the Care and Public Health Research Institute (CAPHRI). “Most of them are people with a lower socioeconomic status. It’s no secret that smoking is bad for you, but it’s very difficult to stop. As a country, we are still looking for ways to help people quit smoking. In 2009, a study on financial incentives to encourage smoking cessation was published in the US. It inspired Onno van Schayck, professor of Prevention in Primary Care, to initiate this study.”

Financial incentive

The study set out to investigate the effect of employers providing financial incentives to help their employees quit smoking. “We found 604 smokers who wanted to quit, from 61 different companies. All participants attended a group training programme on smoking cessation, provided by a professional coach. Half of the participants also received a reward: gift vouchers worth €350 in total. Participants who quit smoking received €50 after completing the programme. They received another €50 after 3 months, another €50 after 6 months, and €200 after 12 months. A year later, it turned out that some participants had started smoking again, but there was a substantial difference between the group of people who had only attended the training programme and the group of people who had also received a financial incentive. The quit rate was 26% versus 41%. The success rate for people who try to quit smoking by themselves is 5 to 10%. In other words, even just 26% is a huge success: a workplace-based group training programme encourages smoking cessation. Participants can support each other and it’s easily accessible. The study also showed that combining a workplace-based group training programme on smoking cessation with a financial incentive ­– vouchers – leads to even higher success rates.”

If all employers in the country introduced this incentive scheme, it could make a valuable contribution to reducing smoking rates in the Netherlands. “That’s why our team is conducting a follow-up study to find out how to get employers on board. And how to encourage employees, particularly employees with a lower socioeconomic status, to participate.”

Stronger together

The implementation project is called “Samen Sterker Stoppen” (“Stop Smoking: Stronger Together”). “It’s a golden opportunity”, says Gera Nagelhout, professor at UM and Chief Science Officer at IVO, the Dutch institute for research on lifestyles and addiction. “We’ll now have to work hard to get employers involved in the project and develop the necessary materials. We’re essentially conducting research and implementing our method at the same time. We’re doing this together with other parties, such as SineFuma, a company that provides training programmes on smoking cessation, and Pharos, the Dutch Centre of Expertise on Health Disparities. And we’re working with employers, employees and other stakeholders. We’ve seen that people are very motivated to tackle this problem together. It’s quite exceptional for us to be working with organisations in a practical context like this. It provides us with real-world insights that we wouldn’t just come across in a purely theoretical context.”

The first steps of the project have already been taken. A website, materials and a communication strategy have been developed, and companies have been approached about the project. After the summer, employers will attend a webinar to learn how to start a one-on-one conversation with their employees about quitting smoking by participating in a training programme.

• Van den Brand FA, Nagelhout GE, Winkens B, Chavannes NH, van Schayck OCP. Effect of a workplace-based group training program combined with financial incentives on smoking cessation: a cluster-randomized controlled trial. The Lancet Public Health. 2018;3(11):e536–e544. doi:10.1016/S2468-2667(18)30185-3
• Van den Brand, F.A.; Dohmen, L.M.E.; Van Schayck, O.C.P.; Nagelhout, G.E. ‘Secretly, it’s a competition’: a qualitative study investigating what helped employees quit smoking during a workplace smoking cessation group training programme with incentives. BMJ Open 2018, 8, e023917. doi: 10.1136/bmjopen-2018-023917
• Van den Brand, F. A., Nagelhout, G. E., Winkens, B., Chavannes, N. H., van Schayck, O. C. P., and Evers, S. M. A. A. (2020) Cost‐effectiveness and cost–utility analysis of a work‐place smoking cessation intervention with and without financial incentives. Addiction, 115: 534– 545. doi:https://doi.org/10.1111/add.14861
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• Van den Brand, F.A.; Nagtzaam, P.; Nagelhout, G.E.; Winkens, B.; van Schayck, C.P. The Association of Peer Smoking Behavior and Social Support with Quit Success in Employees Who Participated in a Smoking Cessation Intervention at the Workplace. Int. J. Environ. Res. Public Health 2019, 16, 2831. doi:10.3390/ijerph16162831

   

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