Nearly twice as many people quit smoking when offered cash rewards

In a Penn Medicine trial of more than 3,200 adults undergoing lung cancer screening, cash rewards plus free medication helped more people quit than usual care.

Offering financial incentives of up to $600 nearly doubled smoking cessation rates among medically underserved adults undergoing lung cancer screening, according to a large randomized clinical trial. The findings were published today in JAMA.

The study, led by researchers from the Perelman School of Medicine at the University of Pennsylvania and collaborators nationwide, enrolled more than 3,200 patients referred for low-dose CT lung cancer screening who still actively smoke tobacco across Penn Medicine, Geisinger, Henry Ford Health, and Kaiser Permanente Southern California. Annual lung cancer screening is currently recommended for adults ages 50 to 80 who have at least a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Participants were predominantly from populations that traditionally face barriers to high-quality health care, including individuals with lower incomes, those living in rural communities, and Black and Hispanic adults.

“These participants had smoked for decades and likely made multiple unsuccessful quit attempts in the past. We found that adding financial incentives increased quit rates in a population that can be especially difficult to reach with traditional smoking cessation approaches,” said senior author Scott D. Halpern, MD, PhD, director of the Palliative and Advanced Illness Research (PAIR) Center at Penn.

Smoking is the leading cause of preventable illness and death worldwide. While rates have drastically declined since the 1960s, smoking is still estimated to cause about 450,000 deaths in the U.S. each year.

Comparing strategies used to quit smoking: Researchers tested four smoking cessation strategies: standard ask-advise-refer care, which included referrals to resources available in the community or health system; standard care plus free smoking cessation medications; standard care plus free medications and financial incentives; and the same package plus a text-based behavioral tool called FutureMe, which prompted participants to imagine their future smoke-free selves.

After six months, smoking abstinence rates, confirmed through blood or urine tests, were:
    3 percent with usual care alone
    1 percent with free smoking cessation medications
    8 percent with free medications plus financial incentives
    2 percent with free medications, incentives, and FutureMe

The findings showed that financial incentives led to higher quit rates than usual care and free medications alone. Participants could earn up to $600 through a series of payments contingent on providing a blood or urine sample that verified smoking cessation: $100 at two weeks, $200 at three months, and $300 at six months.

The study is believed to be the largest trial to evaluate financial incentives for smoking cessation among patients referred for lung cancer screening and one of the largest conducted among medically underserved populations. “Finding new approaches that help people successfully stop smoking can have an enormous impact, not only on their health but also on their quality of life,” said Joanna L. Hart, MD, an assistant professor in Pulmonary, Allergy and Critical Care and the study’s lead author.

The investigators are now exploring how best to implement incentive-based cessation programs more broadly and studying public perceptions of paying people to quit smoking.

Editor’s Note: Research reported in this study was funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Award (PCS-2018C1-11326). The statements presented in this report are solely the responsibility of the authors and do not necessarily represent the views of the PCORI®.

Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service.

The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.

By the Perelman School of Medicine at the University of Pennsylvania, via Newswise. The Gayly Online. 10/5/26 @ 2:16 p.m. CST.