Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Do Smoking Cessation Incentives Aid in Abstinence?

N Engl J Med; 2018 Jun 14; Halpern, et al

Financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence compared to free cessation aids alone, a recent study found. Researchers randomly assigned smokers employed by 54 companies to 1 of 4 smoking cessation interventions or to usual care. The 4 interventions consisted of usual care (access to information regarding the benefits of smoking cessation and a motivational text-message service) plus 1 of the following: free cessation aids; free e-cigarettes, without a requirement that standard therapies had been tried; free cessation aids plus $600 in rewards for sustained abstinence; or free cessation aids plus $600 in redeemable funds, deposited in a separate account for each participant, with money removed if cessation milestones were not met. The primary outcome was sustained smoking abstinence for 6 months after the target quit date. Among the details:

  • Among 6,131 smokers enrolled, 6,006 underwent randomization.
  • Though 6 months, sustained abstinence rates were 0.1% in the usual care group, 0.5% in the free cessation aids group, 1.0% in the free e-cigarettes group, 2.0% in the rewards group, and 2.9% in the redeemable deposit group.
  • The addition of free cessation aids or e-cigarettes did not provide a benefit among smokers who received usual care.


Halpern SD, Harhay MO, Saulsgiver K, et al. A pragmatic trial of e-cigarettes, incentives, and drugs for smoking cessation. N Engl J Med. 2018;378:2302-2310. doi:10.1056/NEJMsa1715757.