Paying employees to quit smoking pays off
CAPHRI research contributes directly to making our society healthier
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.”
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.”
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.
Positive impact on health
Gera and Floor hope that a lot of employers will participate in the project. They’re positive about it, and proud of what they have already achieved. “This project has already helped so many people quit smoking”, says Floor. “I’ve received emails from very happy participants. It’s amazing to be able to contribute to that.”
“We’re already helping people while conducting our research”, adds Gera. “The result is immediate: we’re having a positive impact on people’s health. It’s wonderful.”
Text: Antoinette van der Vorst - annie creatief tekstwerk
This animated video (in Dutch) shows the benefits of combining a smoking cessation training programme with financial incentives for companies.
- Dr. Floor van den Brand, postdoctoral researcher, Department Family Medicine (UM)
- Prof.dr. Gera Nagelhout, Endowed Prof. in Health and Wellbeing of People with a Lower Socioeconomic Position, Department Health Promotion (UM) en Chief Science Officer IVO
- Prof.dr. Onno van Schayck, Prof. of Prevention in Primary Care, Department Family Medicine (UM)
- Lotte de Haan-Bouma, Msc. Research assistent, Department Family Medicine (UM)
- Dr. Bjorn Winkens, Assistent professor, Department Methodology and Statistics (UM)
- Prof.dr. Niels Chavannes, Professor General Practice, Leiden University Medical Center
Involved Research Lines
- Optimising Patient Care
- Promoting Health and Personalised Care
- Fire Brigade South-Limburg
- Centre for Motivation and Change (CMC)
- Heartbeat Ventures
- Rotterdam University of Applied Sciences
- Human Capital Care
- Lung Alliance Nederlands
- Leiden University Medical Centre
- Research Institute IVO
- Trimbos Institute
- Zilveren Kruis
There’s a clear trend in society of people continuing to work later in life, staying healthy and remaining independent for longer, and keeping their healthcare costs as low as possible. So why not invest in people to support them in this?
Waste and energy company AVR has successfully introduced smoking cessation training programmes with incentives. Their experiences can be found here (video in Dutch).
In the media
Earning money by losing weight, that becomes possible for residents of Amersfoort. The municipality is starting an experiment to ensure that people change their lifestyle in a positive way. Will we achieve our goals sooner if we receive financial incentives? The reporter of the TV programme Editie NL consulted Floor van den Brand, who showed that people are more likely to stop smoking if they are rewarded for doing so.
- Article by the Netherlands Society of Occupational Medicine titled: “De beloning wordt vaak gebruikt om de overwinning op de sigaret te vieren”.
- Article by the Dutch Hospital Association (NVZ) titled: 'Medewerkers helpen stoppen met roken? Belonen werkt!'
- Interview with Puck Nagtzaam (intern) for the podcast of the Dutch Journal of Medicine.
- Article in the Dutch Journal of Medicine titled: 'Sociale collega helpt bij stoppen met roken'.
- Article in newspaper De Telegraaf titled: 'Stoppen met roken? Collega’s kunnen helpen'.
- Video: television programme Editie NL (RTL4).
- Video: newsprogramme Limburg Centraal (regional broadcasting company L1)
- Radio show regional broadcasting company L1 (https://bit.ly/2OwM9U9)
- Website 1Limburg https://bit.ly/2pYaR0G.
- Article newspaper NRC.
- Video: Television programme Hart van Nederland (SBS 6).
- Video: RTL News programme.
Website Dutch Broadcasting Foundation (NOS).
Radio news show (Radio 1 Journaal) https://bit.ly/2pYe14F.
Our most important scientific output
Watch the webinar here.
Speakers: Prof. dr. Onno van Schayck, Prof. dr. Gera Nagelhout, Dr. Floor van den Brand, Nienke Boderie, Msc., Lesley Sinclair, Prof. dr. Scott D. Halpern.
Tobacco smoking is a major health problem. To reduce smoking in society and establish a smoke-free generation, effective interventions are needed to help people quit smoking. How can financial rewards for smoking cessation contribute to decreasing smoking prevalence? In this symposium, organized on 21 October 2020 by Maastricht University and the IVO research institute, international experts in the field of smoking cessation present their research.
Webinar: Incentives for Smoking Cessation
- 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
- Van den Brand, F.A.; Candel, M. J. J. M.; Nagelhout, G.E.; Winkens, B.; Van Schayck, C.P. How financial incentives increase smoking cessation: a two-level path analysis. Nicotine & Tobacco Research 2020; ntaa024. doi:10.1093/ntr/ntaa024
- 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
- Van den Brand, F.A.; Magnée, T.; de Haan-Bouma, L.; Barendregt, C.; Chavannes, N.H.; van Schayck, O.C.P.; Nagelhout, G.E. Implementation of Financial Incentives for Successful Smoking Cessation in Real-Life Company Settings: A Qualitative Needs Assessment among Employers. Int. J. Environ. Res. Public Health 2019, 16, 5135. doi:10.3390/ijerph16245135
- Van den Brand, F.A.; Nagelhout, G.E.; Winkens, B.; Evers, S.M.A.A.; Kotz, D.; Chavannes, N.H.; van Schayck, C.P. The effect of financial incentives on top of behavioral support on quit rates in tobacco smoking employees: study protocol of a cluster-randomized trial. BMC Public Health 2016, 16, 1056. doi:10.1186/s12889-016-3729-y
- Van den Brand FA, G Nagelhout, B Winkens, N Chavannes, O van Schayck. Stoppen met roken op het werk. Huisarts & Wetenschap 2019, 62 (5), 19-22.
- Dohmen, L.M.E.; Van den Brand, F.A.; Van Schayck, C.P.; Nagelhout, G.E. Stoppen met roken met je collega’s én een cadeaubon als het lukt. Ned Tijdschr Geneeskd. 2019;163:D3833
- Nagtzaam PF, van den Brand F, Nagelhout G, Winkens B, Chavannes N, van Schayck O. Steun op het werk bij stoppen met roken. Huisarts en wetenschap 2020. doi:10.1007/s12445-020-0593-x