“Financial incentives have been shown to promote a variety of health behaviors. For example, in a randomized, clinical trial involving 878 General Electric employees, a bundle of incentives worth $750 for smoking cessation nearly tripled quit rates, from 5.0% to 14.7% and led to a program adapted by General Electric for its U.S. employees. Although incentive programs are increasingly used by governments, employers, and insurers to motivate changes in health behavior, their design is usually based on the traditional economic assumption that the size of the incentive determines its effectiveness. In contrast, behavioral economic theory suggests that incentives of similar size may have very different effects depending on how they are designed. For example, deposit or “commitment” contracts, whereby participants put some of their own money at risk and recoup it if they are successful in changing their behavior, have been used in a variety of online and employer-based behavioral-change programs. Because people are typically more motivated to avoid losses than to seek gains,13 deposit contracts should be more successful than reward programs. However, the need to make deposits may deter people from participating, and the overall effectiveness of deposit and reward programs has not been compared. Furthermore, incentives that target groups may be more effective than incentives that target individuals because people are strongly motivated by social comparisons.16-18 Collaborative incentives, whereby payments to successful group members increase with the overall success of the group, may add dimensions of interpersonal accountability and teamwork.19 Competitive designs, such as pari-mutuel schemes in which money deposited by group members who do not change their behavior gets distributed to group members who do, may amplify peoples’ aversions to loss by highlighting the regret they may feel if others benefit from their failure to change. We therefore evaluated incentive programs for smoking cessation that are based on rewards or deposit contracts and that are delivered at the individual or group level, comparing the interventions on three measures: acceptance, defined as the proportion of people who accept the incentive program when offered; overall effectiveness, assessed as the proportion of people offered each program who stop smoking; and efficacy, assessed as the proportion of people who stop smoking if they accept a given incentive program.”

Randomized Trial of Four Financial-Incentive Programs for Smoking Cessatio – Supplementary Material

• Supplementary Appendix
• Disclosure Forms
• Protocol