Smokers' perceptions of incentivised smoking cessation programmes: Examining how payment thresholds change with income

Introduction: Studies demonstrate that financial incentive programmes increase smoking cessation. However, there is little guidance on which incentive magnitudes will ensure optimal enrolment and motivation levels. This study investigates current smokers' perceptions of varying incentive magnitudes to identify whether there is evidence for optimal amount(s), and whether perceptions differ by income group.

Methods: Studies 1 (N = 56) and 2 (N = 147) were conducted online via Prolific.co. Current smokers were randomly shown multiple hypothetical incentive programmes which differed only in the incentive amount offered. For each programme, smokers rated its appeal, their likelihood of enrolling, and predicted their motivation to quit if enrolled. Growth models were used to investigate the relationship between perspectives and the incentive amount.

Results: An increasing quadratic trend in smokers' perceptions of programmes as the incentive amount increased was identified. Incentive amounts beyond approximately £50-75/week (£500 to £750 total) did not significantly alter perceptions of programmes. In Study 2, high-income smokers found programmes 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 middle-income smokers.

Conclusions: Increasing the incentive amount increased smoker's perceptions of programmes. This relationship was curvilinear, meaning there may be a point beyond which further increasing the amount will not improve enrolment or motivation levels. Incentives appear equally appealing to low- and middle-income smokers; the population among whom smoking is most prevalent. Future research could explore other elements of programme design, and whether findings hold under real-world conditions.

Implications: While acknowledging that they work, policymakers frequently request information about the monetary amount needed for incentive programmes to be effective, and if this differs by income level. We investigated these questions using smokers' perceptions of hypothetical cessation programmes which differed in the amount offered. An increasing quadratic trend in perceptions of programmes by the amount and potential cut-points were observed, suggesting a point may exist beyond which increasing the incentive will not improve perceptions of programmes or enrolment levels. High-income smokers may not perceive incentives to be as appealing as other income groups, but appear equally willing to enrol.