Smokers’ perceptions of incentivised smoking cessation programmes: examining how payment thresholds change with income

Significance

Studies demonstrate financial incentive programmes increase smoking cessation success. Yet there is little guidance on the incentive amount necessary to ensure optimal enrolment and motivation levels. Whether the amount should differ between recipients, including by income level, is also uncertain. These are key questions policy makers consider before the implementation of incentive programmes. Here we investigate current smokers’ perceptions of varying amounts to identify whether there is evidence for optimal amount(s), and whether perceptions of amounts differ by income.

Methods

In Studies 1 (N=56) and 2 (N=147), current smokers were randomly shown multiple hypothetical programmes which differed only in the incentive amount offered. For each programme, smokers rated its appeal, their likelihood of enrolling, and predicted their motivated to quit if enrolled. Growth models were used to investigate the relationship between smoker’s perspectives and incentive amounts.

Results

An increasing quadratic trend in smokers’ perspectives of programmes as the incentive amount increased was identified. Potential cut-points at £50 to £75 per week (£500 to £750 total across the programme) were observed, beyond which further increases to the amount did not significantly alter perceptions of programmes. In Study 2, high-income smokers rated all programmes as significantly less appealing and motivating than low-income smokers, although no significant between-group differences were observed in the likelihood of enrolment. No significant differences were observed between low- and middleincome smokers.

Conclusions

Increasing the incentive amount increases smoker’s perspectives of incentive programmes and their predicted enrolment. This relationship is likely curvilinear, meaning a point beyond which further increasing the amount will not improve enrolments or motivation to quit may exist. Incentives appear equally appealing to low- and middle-income smokers; the population among whom smoking is most prevalent. Future research is needed to determine whether other programme or recipient characteristics influence the amount desired, and to consider effectiveness.