Study: Paying smokers to quit boosts success rate

By LINDA A. JOHNSON

12 feb 2009--Dangling enough dollars in front of smokers who want to quit helps many more succeed, an experiment with hundreds of General Electric Co. workers indicates. Among those paid up to $750 to quit and stay off cigarettes, 15 percent were still tobacco-free about a year later. That may not sound like much, but it's three times the success rate of a comparison group that got no such bonuses.

GE was so impressed it plans to offer an incentive program nationwide next year, aiming to save some of the company's estimated $50 million annually in extra health and other costs for smoking employees.

"This kind of reward system provides them with direct, positive feedback in the present," not just delayed, intangible health benefits, said Dr. Kevin Volpp, the lead researcher of the study.

Volpp, who oversees the health incentives center at the University of Pennsylvania, called the study the largest ever of employer incentives to stop smoking. Several past studies failed to find higher quit rates linked to financial bonuses, but he said those included too few people or the financial incentives were too tiny, some as low as $10.

The $750 was "a good incentive," said Dan Anzalone, a study participant who quit smoking cold turkey three years ago next month — after a 35-year habit.

"I was getting rewarded for something that I should be doing anyway," said Anzalone, 54. "You'd be surprised at what that little incentive does."

A logistics specialist at a GE plant in Schenectady, N.Y., Anzalone tried quitting with antidepressants about seven years ago but couldn't. He tried quitting on New Year's Day most years, but generally only lasted a couple days.

So he signed up for Penn's federally funded study, unaware that he would be paid. Half the 878 participants, at about 85 U.S. GE sites, were put in the financial rewards group; the other half were just encouraged to join quit-smoking programs and use the company's health coverage for doctor visits and anti-smoking drugs.

Results of the study, which began in 2005, were reported in Thursday's New England Journal of Medicine.

The incentive group got increasingly higher payments the longer they stayed off tobacco, up to a total of $750 after 12 months.

Anzalone said the incentive program was all he needed: He didn't go to smoking cessation classes or use nicotine patches or gum, or medicines.

"Every week got easier and easier," he said. "Now it's been three years and I don't even think about it."

The study showed that after nine to 12 months, about 15 percent of those being paid had stayed off cigarettes, compared to just 5 percent of the unpaid group. In addition, four times as many people getting cash completed a smoking cessation program.

Volpp said similar numbers of people in the two groups used aids such as nicotine patches and the drug Zyban, which reduces irritability and depression.

Dr. Norman Edelman, chief medical officer of the American Lung Association, said paying people for healthy behavior remains controversial. But he said the study was well done because it was "more real-world" than the tests drug companies run to get anti-smoking products approved. Study volunteers decided what classes to attend and which products to use, rather than having tightly controlled conditions and constant calls from nurses checking on them, he noted.

Edelman said the 15 percent quit rate is pretty good and that employers should consider trying such a program, although it's not clear it would succeed in settings outside workplaces.

GE's chief medical officer, Dr. Robert Galvin, said Wednesday that starting next January, the company will offer a quitting incentive program covering its 152,000 U.S. employees, at more than 250 sites. GE expects to recoup the costs of the smoking cessation program in three to five years.

"We know that incentives work," Galvin said. "We're very excited about it."

Not all those in the study saw the bonuses as crucial. Guy Ardizzone, 49, an engineer at a GE factory in Madisonville, Ky., smoked for "probably 30 years," then quit nearly three years ago. He said other factors were more important than the $750: completing a 12-week smoking cessation course, using Commit lozenges and his own motivation.

"I was ready to quit," said Ardizzone, who has five young grandchildren. "I want to enjoy them."

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On the Net:

New England Journal: http://www.nejm.org

Alzheimer's risk upped in senior smokers

By Amy Norton

NEW YORK, 10 jan 2009– Older adults who smoke may face an elevated risk of developing Alzheimer's disease, a new study suggests.

In an analysis of two dozen previous studies, UK researchers found that older adults who currently smoked were at greater risk of Alzheimer's than were non-smokers. When the results of the studies were pooled, current smokers had a 79 percent higher risk of the memory-robbing disease.

There was also evidence that smokers had higher risks of other types of dementia, as well as age-related mental decline. However, those links were not statistically significant -- meaning the findings could have been due to chance.

The bottom line, the study's lead researcher told Reuters Health, is that smoking "is likely to be associated with an increased risk of developing Alzheimer's disease."

That should give people one more reason to quit the habit or, better yet, to never start, said Dr. Ruth Peters, of Imperial College London.

She and her colleagues report the findings in the online journal BMC Geriatrics.

Smoking may contribute to dementia in the same way that it affects cardiovascular health -- by damaging the blood vessels and impairing blood flow. As people age, this may accelerate damage to the brain tissue.

On an encouraging note, Peters and her colleagues found that while current smokers had a higher Alzheimer's risk across the studies, former smokers did not.

It's not clear what this means, according to Peters, but it is possible that the excess risk of Alzheimer's declines once smokers quit.

"In any event," she said, "ceasing to smoke is already known to be beneficial in terms of other health outcomes and it is possible that this could apply to dementia also."

SOURCE: BMC Geriatrics, online December 23, 2008.

Older Smokers' Quit Rate Rises with Patches and Phones

By Charles Bankhead
SANTA MONICA, 23 aug 2008-- Older smokers doubled their quit rate when given nicotine patches and access to telephone counseling, showed a Medicare demonstration program.
The one-year quit rate was almost 20% compared with 10% for smokers who received a brochure about smoking cessation (usual care), Geoffrey Joyce, Ph.D., of the RAND Corp. here, and colleagues, reported online in Health Services Research.
Physician counseling and the combination of counseling and medical therapy also led to higher quit rates compared with usual care.
"The results of this study suggest that a fully integrated [Medicare] benefit structured around low-cost pharmacotherapy in conjunction with available free quitline services would substantially reduce the prevalence of smoking and smoking-related illness among elderly beneficiaries motivated to quit, at a relatively modest cost," the authors concluded.
Smoking-cessation efforts have primarily targeted the young, before they become habitual smokers. However, increasing evidence suggests that quitting smoking after decades of exposure can substantially reduce smoking-related illness, the authors noted.
"A person smoking twenty or more cigarettes per day and who quit at age 65 could expect to increase their life expectancy by two to three years, in addition to any improvements in quality of life," they said.
Most private and public health plans do not fully cover smoking-cessation services, in part because of a lack of evidence that insurance coverage increases long-term abstinence, particularly among older adults who often have smoked for decades.
Dr. Joyce and coauthors reported findings from the Medicare Stop Smoking Program, the first large-scale demonstration to test the effectiveness and cost-effectiveness of Medicare coverage for smoking cessation. The study involved 7,354 persons ages 65 and older in seven states (Alabama, Florida, Ohio, Oklahoma, Missouri, Nebraska, and Wyoming).
Medicare beneficiaries in the seven states were recruited into four intervention groups:
A brochure about smoking cessation (usual care).
Reimbursement for four counseling sessions with a physician.
Reimbursement for counseling and smoking-cessation drug therapy (nicotine patches or bupropion [Zyban]).
Nicotine patches plus a telephone hotline.
Any Medicare-eligible primary care clinicians in the study areas could participate in the study and be eligible for reimbursement.
The primary outcome was self-reported smoking cessation at six and 12-months.
Because of the study's nonrandomized design and various recruitment obstacles, enrollment in the four interventions was unbalanced: 2,230 participants were in usual care, 829 in provider counseling, 2,605 in counseling plus optional drug therapy, and 1,690 in nicotine patches plus the telephone hotline.
The six-month quit rates were 9.9% with usual care, 11.9% with provider counseling, 15.8% with counseling plus drug therapy (P=0.05 versus usual care), and 21.2% with nicotine patches plus telephone counseling (P=0.05 versus usual care). At 12 months, the quit rate with usual care (10.2%) was significantly lower compared with each of the other interventions (P=0.05):
14.1% with provider counseling
15.8% with counseling plus drug therapy
19.3% with nicotine patches plus telephone counseling and support
"Rates of confirmed smoking cessation in the Medicare Stop Smoking Program compared favorably with quit rates in the general population and were higher than expected for older adults," the authors said.
Compared with usual care, the additional cost to Medicare for each quitter ranged from $463 with physician counseling alone to $6,450 with nicotine patches and the telephone hotline.
The authors noted several limitations of the study: imbalances in patient enrollment, lack of information about the number and quality of counseling sessions that participants in those groups received, and reliance on self-reported information and cessation rates.
The study was funded by a contract with the Centers for Medicare & Medicaid Services.
The authors reported no conflicts of interest.
Primary source: Health Services ResearchSource reference:Joyce GF et al. "The effectiveness of covering smoking cessation services for Medicare beneficiaries" Health Serv Res 2008; epub.