Evidence suggests that financial incentives can support smoking cessation among pregnant smokers and employees in a workplace setting, and that such schemes are cost-effective. It is possible that wider implementation of incentive schemes could help reduce overall smoking prevalence in New Zealand; however, financial incentives attract controversy and do not tend to be well supported by the general public.
What was our aim?
We investigated how NZ smokers viewed financial incentives for smoking cessation; we explored the overall level of support, support for different types of scheme (employer-funded vs government-funded; reward-only vs deposit-based) and perceived effectiveness.
We surveyed 623 smokers from an internet panel. In addition to questions that assessed support and perceived effectiveness, we included an open-ended question where we invited participants to comment on the idea of financial incentives for smoking cessation; we used qualitative content analysis to analyse these responses.
Financial incentives to stop smoking were supported by 38% of smokers; 42% did not support and 19% had no opinion. Support was higher among heavy and moderate smokers, and those with a recent quit attempt. Support was strongly associated with perceived effectiveness; participants who did not support financial incentives were much more likely to rate them as ‘not at all effective’ compared to participants who did support them (21% versus 2%). Similarly, 21% of those who supported financial incentives rated them as ‘probably’ or ‘very’ effective compared to just 3% of those who did not support them. A Government-funded reward-only scheme was seen as the most acceptable option (preferred by 27% of participants), followed by a Government-funded deposit-based scheme (21%); very few respondents supported employer-funded schemes. Open-ended responses (n=301) indicated three overarching themes expressing opposition to financial incentives: smokers’ individual responsibility for quitting, concerns about abuse of an incentive scheme, and concerns about unfairness.
Conclusions and implications
Even amongst those who would benefit from schemes designed to reward smokers for quitting, support for such schemes is moderate, despite evidence of their effectiveness. Much of the opposition towards financial incentives was underpinned by information gaps. Therefore, media advocacy and health education could be used to increase understanding of, and support for, financial incentives for smoking cessation. Based on NZ smokers’ preference for a government-funded scheme as opposed to workplace-funded schemes, policy-makers could consider primary health care or social welfare organisations as possible settings for wider implementation.
Robertson, L., Gendall, P., Hoek, J., Marsh, L., McGee, R. (2017) Perceptions of financial incentives for smoking cessation: a survey of smokers in a country with an endgame goal, Nicotine & Tobacco Research, ntx268, https://doi.org/10.1093/ntr/ntx268
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University of Otago, Wellington