Randomized trial of four financial-incentive programs for smoking cessation.
Randomized trial of four financial-incentive programs for smoking cessation.
复制标题
DOI：
10.1056/nejmoa1414293
复制
发表时间：
2015-05-28
期刊：
影响因子：
--
通讯作者：
Volpp KG
中科院分区：
文献类型：
--
作者：
Halpern SD;French B;Small DS;Saulsgiver K;Harhay MO;Audrain-McGovern J;Loewenstein G;Brennan TA;Asch DA;Volpp KG
财政激励促进了许多健康行为，但提供健康激励的有效方式仍然不确定。我们随机将CVS Caremark员工和他们的亲戚朋友分配到四个激励计划中的一个，或进行常规的戒烟护理。其中两个激励计划针对的是个人，两个目标群体为六名参与者。其中一个面向个人的项目和一个面向团体的项目需要为戒烟提供大约800美元的奖励；其他项目需要退还150美元的押金，外加650美元的奖励给成功的参与者。通常的护理包括信息资源和免费的戒烟辅助工具。总体而言，共有2538名参与者参加。在那些被分配到以奖励为基础的项目的人中，90.0%的人接受了这一任务，而那些被分配到以存款为基础的项目的人中，这一比例为13.7%(P<；0.001)。在意向治疗分析中，四个激励计划的持续戒烟率(范围为9.4%至16.0%)均高于常规护理(6.0%)(所有比较P<；0.05)；基于奖励的计划的优势持续了12个月。以团体为导向和以个人为导向的计划与类似的6个月禁酒率相关(分别为13.7%和12.1%；P=0.29)。基于奖励的计划与基于存款的计划相比，禁酒率更高(15.7%比10.2%，P<；0.001)。然而，在解释不同接受程度的工具变量分析中，在接受任何一种计划的估计13.7%的参与者中，基于存款的计划比基于奖励的计划在6个月时的禁酒率高出13.2个百分点(95%的可信区间，3.1至22.8)。基于奖励的计划比基于存款的计划更容易被接受，从而导致更高的持续戒烟率。以团体为导向的激励计划并不比以个人为导向的计划更有效。(由美国国立卫生研究院和CVS Caremark资助；ClinicalTrials.gov编号，NCT01526265。)
Financial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain. We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids. Overall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P = 0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program. Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs. (Funded by the National Institutes of Health and CVS Caremark; ClinicalTrials.gov number, NCT01526265.)