Commentary: How Can We Help People Quit Smoking? Pay Them.
Thursday is the 47th year of the American Cancer Society’s Great American Smokeout. One of the longest-running awareness campaigns in the U.S., the Smokeout involves cancer societies, health organizations, and anti-smoking advocates using social and print media to remind Americans that now is the right time to quit.
Each year Americans are subjected to over 200 national health awareness days, weeks, or months. These campaigns cover everything from autism to appropriate use of hospital linens. They are certainly effective in raising awareness over their target issues, a necessary first step in shifting our habits. But awareness campaigns can only be effective if additional anti-smoking supportive efforts—such as offering financial incentives for smokers to quit—are utilized.
Health campaigns do increase awareness. J.W. Ayers and co-authors have shown that the Great American Smokeout campaign increases cessation-related news by about 60%, Twitter posts by 13%, and Internet searches by approximately 25% on the day of the campaign. This increase is roughly 70% of the increase in similar news stories, social media posts, and Internet searches seen on New Year’s Day, which is when people generally set resolutions for the year ahead.
The question of whether increased awareness from the Smokeout translates to increased smoking cessation rates, however, has not been conclusively answered. The closest indicator to success that has been accurately measured is the use of state quitlines, which Ayers and colleagues found increases by about 40% around the time of the Smokeout. There is a positive correlation between the use of quitlines and actual attempts to quit more broadly.
While awareness and public education campaigns are well-intended, providing information alone isn’t enough to help smokers change their behavior. Campaigns should use additional tactics. First, they should introduce smokers to evidence-based approaches and groups that help people quit. This can be done by running search engine advertisements or placing direct links to vetted quitting methods on the campaigns’ social media platforms. Smokers often rely on their own Internet searches to find quitting solutions, and these can be unreliable.
Second, anti-smoking advocates should encourage smokers to set a quit date and to “pre-commit” by telling others of their intentions. Informing others of their intent to quit can be a helpful way to provide reinforcement at times when their own motivation may wane.
Third, campaigns should encourage smokers to enlist their life partners or friends to try to quit at the same time. Quitting is more likely to be successful if others in their social network also cease smoking—and conversely very difficult if others they frequently associate with do not.
Another helpful strategy would be to support anti-smoking efforts by offering financial incentives through health insurance plans. One study found these incentives to be successful in tripling long-term smoking cessation rates in employer settings. And another study found that financial incentives are the most effective approach to increasing tobacco cessation among pregnant women. These incentives offset the natural human tendency to favor immediate gratification over delayed benefits and help make more salient the health and economic benefits to quitting smoking now. In essence, insurers and employers are passing on some of their future savings from reduced health expenditures to smokers who successfully quit.
Awareness campaigns are a highly visible part of the American public health landscape and that is a good thing. But they’ll need support. Anti-smoking advocates need to disseminate advice about effective behavior change strategies and encourage health plan benefit designs that invest in preventing disease, as opposed to simply treating the health consequences of smoking. This would increase the impact of awareness campaigns in improving health.
Kevin G. Volpp is the Janet and John Haas president’s distinguished professor at the Perleman School of Medicine and the Wharton School, and director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania. Follow him on Twitter. Kathryn A. Saulsgiver is a senior research associate at the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania.