Within Rewards
Can Paying People Help Them Quit Smoking?
Smoking cessation incentives show how rewards can help when the stakes are high and the behaviour is hard to start.
On this page
- What smoking cessation incentive studies find
- Why verification and timing matter
- What quit smoking rewards teach self improvement plans
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Introduction
Financial incentives for quitting smoking are one of the clearest real-world tests of whether rewards can help people change difficult behaviour. Unlike many self-improvement techniques, smoking cessation has been studied in large randomised trials, workplace programmes, healthcare systems, and public health interventions. The question is straightforward: if people are paid, rewarded, or given vouchers for verified abstinence, do more of them quit?
The evidence increasingly suggests that the answer is yes. Financial incentives do not work for everyone, and they are not a substitute for motivation, treatment, or support. However, well-designed incentive programmes consistently increase long-term quit rates compared with standard care alone. In the wider discussion of rewards versus bribery, smoking cessation provides one of the strongest examples of rewards acting as a useful bridge between immediate effort and distant benefits. [Cochrane Library]cochranelibrary.comCochrane Library Incentives for smoking cessationCochrane LibraryIncentives for smoking cessation - Notley, C - 2019by C Notley · 2019 · Cited by 613 — Overall there is high‐certainty ev… [Cochrane]cochrane.orgCochraneCan rewards help people quit smoking, and do they work…13 Jan 2025 — Financial incentives (money, vouchers, or self-deposits)…
What Smoking Cessation Incentive Studies Find
Research on smoking cessation incentives has accumulated over decades, culminating in large systematic reviews and meta-analyses. The strongest recent evidence comes from Cochrane reviews, which found high-certainty evidence that financial incentives improve smoking cessation rates at follow-up periods of six months or longer. Importantly, the benefits often persist after the incentives themselves have ended. [Cochrane Library]cochranelibrary.comCochrane Library Incentives for smoking cessationCochrane LibraryIncentives for smoking cessation - Notley, C - 2019by C Notley · 2019 · Cited by 613 — Overall there is high‐certainty ev… PubMed One influential workplace study published in the [pubmed.ncbi.nlm.nih.gov]pubmed.ncbi.nlm.nih.govPubMedIncentives for smoking cessationby C Notley · 2019 · Cited by 615 — Overall there is high-certainty evidence that incentives improv…New England Journal of Medicine offered employees financial rewards worth up to $750. Participants receiving incentives were substantially more likely to quit smoking and remain abstinent than those receiving standard information and support alone. The programme increased participation in cessation services as well as successful quitting. [New England Journal of Medicine]nejm.orgNew England Journal of MedicineA Randomized, Controlled Trial of Financial Incentives for…by KG Volpp · 2009 · Cited by 1086 — In this… [ovid]ovid.comA Randomized, Controlled Trial of Financial Incentives…by KG Volpp · 2009 · Cited by 1085 — The financial incentives were $100 for com… A later trial compared several incentive structures, including straightforward rewards and deposit contracts in which participants risked losing money they had put forward themselves. All incentive approaches outperformed usual care among those who engaged with them. However, reward-based programmes attracted far more participants than deposit-based schemes, making them more effective in practice. [New England Journal of Medicine]nejm.orgNew England Journal of MedicineA Randomized, Controlled Trial of Financial Incentives for…by KG Volpp · 2009 · Cited by 1086 — In this… PubMed This distinction matters. Behavioural economists often note that people are highly motivated to avoid losses [pubmed.ncbi.nlm.nih.gov]pubmed.ncbi.nlm.nih.govPubMedIncentives for smoking cessationby C Notley · 2019 · Cited by 615 — Overall there is high-certainty evidence that incentives improv…, yet programmes that require participants to risk their own money may be psychologically powerful but less appealing to join. In real-world settings, a slightly less powerful incentive that many people accept may outperform a theoretically stronger one that few people choose. [New England Journal of Medicine]nejm.orgNew England Journal of MedicineA Randomized, Controlled Trial of Financial Incentives for…by KG Volpp · 2009 · Cited by 1086 — In this… [New England Journal of Medicine]nejm.orgNew England Journal of MedicineA Randomized, Controlled Trial of Financial Incentives for…by KG Volpp · 2009 · Cited by 1086 — In this…
Results in High-Risk Groups
The evidence is particularly striking in pregnancy, where smoking carries serious risks for both parent and child. Multiple trials have found that financial incentives increase cessation rates during pregnancy. A large Scottish trial reported substantially higher quit rates among women offered incentives than among those receiving standard support alone. [BMJ]bmj.comSignificantly more smokers offered incentives stopped…Read more…
Recent reviews have strengthened confidence in these findings. Updated analyses indicate that financial rewards improve smoking cessation outcomes during pregnancy and may contribute to better birth outcomes, including higher birth weights. Researchers now describe the evidence in this area as strong enough to support broader implementation discussions rather than simply further proof-of-concept testing. [PubMed]pubmed.ncbi.nlm.nih.govPubMedIncentives for smoking cessationby C Notley · 2019 · Cited by 615 — Overall there is high-certainty evidence that incentives improv… [UMass Amherst]umass.edufinancial incentives help people quit smokingUMass AmherstFinancial Incentives Found to Help People Quit Smoking…14 Jan 2025 — Rewards and financial incentives are successful met…
Why Verification and Timing Matter
One reason smoking cessation incentives work better than many informal self-reward systems is that the target behaviour can be verified objectively.
Most successful programmes do not simply ask participants whether they have quit. They use biochemical verification, such as breath carbon monoxide testing or other measures of tobacco abstinence. Rewards are contingent on demonstrated results rather than intentions. This reduces gaming of the system and strengthens the link between behaviour and reward. PubMed [Ovid]ovid.comA Randomized, Controlled Trial of Financial Incentives…by KG Volpp · 2009 · Cited by 1085 — The financial incentives were $100 for com…
Timing is equally important. Smoking creates immediate rewards through nicotine while the benefits of quitting often arrive slowly. Better health, lower disease risk, and financial savings may take months or years to become emotionally meaningful. Incentives partially solve this timing problem by introducing immediate positive consequences for staying smoke-free. Cochrane [PubMed Central]pmc.ncbi.nlm.nih.govA recent Cochrane review by Notley et…Read more…
The most effective programmes often use a sequence of rewards rather than a single payment. Small incentives may be delivered for early milestones, followed by larger rewards for sustained abstinence. This structure helps participants navigate the difficult first weeks while continuing to reinforce longer-term success. Cochrane [PubMed Central]pmc.ncbi.nlm.nih.govA recent Cochrane review by Notley et…Read more…
Interestingly, evidence suggests that simply increasing reward size does not always produce proportionally larger effects. Some analyses indicate that programme design, accessibility, and timing can matter as much as the absolute amount of money involved. Tobacco Prevention & Cessation [PubMed Central]pmc.ncbi.nlm.nih.govA recent Cochrane review by Notley et…Read more…
Why the Idea Remains Controversial
Despite strong evidence, paying people to quit smoking often generates resistance. [umass.edu]umass.edufinancial incentives help people quit smokingUMass AmherstFinancial Incentives Found to Help People Quit Smoking…14 Jan 2025 — Rewards and financial incentives are successful met…
One objection is fairness. Non-smokers sometimes ask why people should receive rewards for stopping a harmful habit when others never started. Another concern is that external rewards might undermine personal responsibility or intrinsic motivation. Critics worry that people will quit only for the money and relapse once payments stop. [PubMed Central]pmc.ncbi.nlm.nih.govA recent Cochrane review by Notley et…Read more…
The empirical evidence has generally not supported the strongest version of this concern. Long-term follow-up studies show that incentive programmes improve abstinence rates even after rewards are withdrawn. If incentives merely purchased temporary compliance, these gains would be expected to disappear quickly once payments ended. Instead, many participants appear to use the incentive period to establish a genuinely different pattern of behaviour. PubMed [Cochrane Library]cochranelibrary.comCochrane Library Incentives for smoking cessationCochrane LibraryIncentives for smoking cessation - Notley, C - 2019by C Notley · 2019 · Cited by 613 — Overall there is high‐certainty ev…
A more practical debate concerns implementation. Successful programmes require verification systems, administrative support, and funding. Researchers increasingly focus not on whether incentives work but on how to integrate them efficiently into existing healthcare and public health services. [Tobacco Control]tobaccocontrol.bmj.comincentives for smoking cessation among…by L van der Spek · 2025 · Cited by 3 — This systematic review offers new insights into the cha… [Tobacco Control]tobaccocontrol.bmj.comTobacco ControlFinancial incentives for smoking cessation among…by L van der Spek · 2025 · Cited by 3 — This systematic review offers…
What Quit-Smoking Rewards Teach Self-Improvement Plans
Smoking cessation incentives offer an unusually clear lesson about rewards in behaviour change.
First, rewards appear most useful when the behaviour is difficult, the benefits are delayed, and the costs of failure are high. Quitting smoking fits all three conditions. The evidence is stronger here than in many lower-stakes self-improvement contexts because the challenge is substantial and measurable. [Cochrane Library]cochranelibrary.comCochrane Library Incentives for smoking cessationCochrane LibraryIncentives for smoking cessation - Notley, C - 2019by C Notley · 2019 · Cited by 613 — Overall there is high‐certainty ev… [PubMed Central]pmc.ncbi.nlm.nih.govA recent Cochrane review by Notley et…Read more…
Second, rewards work best when they reinforce specific actions or outcomes rather than vaguely encouraging good intentions. Smoking cessation programmes reward verified abstinence, not aspirations. The target is concrete, observable, and time-bound. PubMed [Ovid]ovid.comA Randomized, Controlled Trial of Financial Incentives…by KG Volpp · 2009 · Cited by 1085 — The financial incentives were $100 for com…
Third, incentives are often most effective as temporary scaffolding. They help people persist through the period when a new behaviour has not yet become self-sustaining. Once abstinence becomes normal and the benefits of quitting become personally meaningful, the reward can step back. The goal is not lifelong payment but successful transition. [PubMed]pubmed.ncbi.nlm.nih.govPubMedIncentives for smoking cessationby C Notley · 2019 · Cited by 615 — Overall there is high-certainty evidence that incentives improv… [JAMA Network]jamanetwork.comFinancial Incentives for Smoking Cessation Among…by DE Kendzor · 2024 · Cited by 17 — A 2019 review concluded that offering incentives…
For the broader question of “self improvement that works”, financial incentives for quitting smoking demonstrate that rewards are neither magical nor inherently corrupting. When carefully targeted, verified, and timed, they can help people overcome one of the most difficult behaviour changes studied in modern health research. That makes smoking cessation one of the strongest pieces of evidence that external rewards can reinforce change without simply becoming a bribe. [Cochrane Library]cochranelibrary.comCochrane Library Incentives for smoking cessationCochrane LibraryIncentives for smoking cessation - Notley, C - 2019by C Notley · 2019 · Cited by 613 — Overall there is high‐certainty ev… [Cochrane]cochrane.orgfeatured review incentives smoking cessation 0Featured Review: Incentives for smoking cessationJul 17, 2019 — Evidence published in the Cochrane Library provides strong evidence that…
Amazon book picks
Further Reading
Books and field guides related to Can Paying People Help Them Quit Smoking?. Use these as the next step if you want deeper reading beyond the article.
The Easy Way to Stop Smoking
Directly addresses smoking cessation and behaviour change.
Atomic Habits
Rating: 3.5/5 from 7 Google Books ratings
Explains rewards, cues and habit change mechanisms relevant to quitting smoking.
The Power of Habit
Shows how habit loops can be altered in addiction-related behaviours.
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Endnotes
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Source: cochrane.org
Link: https://www.cochrane.org/evidence/CD004307_can-rewards-help-people-quit-smoking-and-do-they-work-long-termSource snippet
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Significantly more smokers offered incentives stopped...Read more...
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Source: umass.edu
Title: financial incentives help people quit smoking
Link: https://www.umass.edu/public-health-sciences/news/financial-incentives-help-people-quit-smokingSource snippet
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incentives for smoking cessation among...by L van der Spek · 2025 · Cited by 3 — This systematic review offers new insights into the cha...
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Title: featured review incentives smoking cessation 0
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New England Journal of MedicineNudging Smokers13 May 2015 — The first is a “deposit program,” in which smokers deposit $150, which they c...
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A recent Cochrane review by Notley et...Read more...
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PMC - NIHby G Valentelyte · 2024 · Cited by 7 — Financial incentives to stop smoking (FISS) programs have been implemented internationall...
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But these interventions might have possible adverse effects.Read more...
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Source: theincidentaleconomist.com
Title: paying people to quit smoking
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27 May 2015 — “Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation“: BACKGROUND: Financial incentives promote man...
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Financial Incentives for Smoking Cessation Among...by DE Kendzor · 2024 · Cited by 17 — A 2019 review concluded that offering incentives...
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incentives for smoking cessation in low-income...by JF Etter · 2012 · Cited by 20 — A recent study showed that financial incentives of u...
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of providing financial incentives to healthcare...The review concluded that financial incentives for healthcare professionals appeared t...
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randomized, controlled trial of financial incentives for...12 Feb 2009 — The financial incentives were $100 for completion of a smoking...
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Incentives to Improve Smoking CessationPrevious studies have shown that financial incentives improve abstinence rates, but questions rema...
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Financial Incentives for Smoking Cessation in Pregnancy...by C Notley · 2025 · Cited by 1 — A randomized controlled trial of financial i...
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for smoking cessation - UKHSA Research Portalby C Notley · 2019 · Cited by 604 — Authors' conclusions Overall there is high-certainty evi...
Additional References
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Source: nice.org.uk
Link: https://www.nice.org.uk/guidance/ng209/evidence/i-incentives-during-pregnancy-pdf-10890777859Source snippet
[I] Evidence reviews for incentives during pregnancyNICE guideline PH26 previously considered some evidence (3 randomised controlled tria...
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Source: tobaccopreventioncessation.com
Link: https://www.tobaccopreventioncessation.com/Financial-incentives-to-stop-smoking-Potential-financial-consequences-of-different%2C190617%2C0%2C2.htmlSource snippet
Tobacco Prevention & CessationFinancial incentives to stop smokingby G Valentelyte · 2024 · Cited by 7 — Higher incentive amounts do not...
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Source: news-medical.net
Link: https://www.news-medical.net/news/20250113/Financial-incentives-prove-successful-in-supporting-pregnant-smokers-to-quit.aspxSource snippet
Financial incentives prove successful in supporting...13 Jan 2025 — Rewards and financial incentives are successful methods to help peop...
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Source: ilcn.org
Link: https://www.ilcn.org/financial-incentives-and-free-treatment-aids-for-smoking-cessation-in-the-workplace/Source snippet
t on biochemically verified quitting, resulted in superior sustained 6-month quit rates (9.4% to 16.0%)...Read more...
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Source: newswise.com
Title: penn study finds that various financial incentives help smokers quit
Link: https://www.newswise.com/articles/penn-study-finds-that-various-financial-incentives-help-smokers-quitSource snippet
Penn Study Finds That Various Financial Incentives Help...11 May 2015 — Four different financial incentive programs, each worth roughly...
Published: May 2015
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Source: 2minutemedicine.com
Title: financial incentive programs significantly improve smoking cessation
Link: https://www.2minutemedicine.com/financial-incentive-programs-significantly-improve-smoking-cessation/Source snippet
All four financial incentive programs tested led to significantly higher rates of abstinence from smoking at 6 months compared to usual...
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Source: ldi.upenn.edu
Title: Penn LDINEJM Paper on Financial Incentives for Smoking Cessation
Link: https://ldi.upenn.edu/wp-content/uploads/static-pages/50at50/nejm-paper-financial-incentives-smoking-cessation.htmlSource snippet
financial incentives. In a randomized trial among GE employees, the group found that a bundle of incentives worth $750 nearly tripled smo...
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Source: davidgratzer.com
Title: reading of the week smoking cessation incentives the nejm paper
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Reading of the Week: Smoking Cessation & Incentives21 Jun 2018 — Among participants in the engaged cohort, the rate of sustained smoking...
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Source: medicalxpress.com
Title: 2025 01 financial rewards significantly cessation pregnancy
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Financial rewards significantly increase smoking cessation...13 Jan 2025 — For every 100 pregnant persons who received financial incenti...
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Paying people to quit smoking promotes sustained...15 May 2015 — Researchers recruited smokers who had a desire to quit into a randomise...
Published: May 2015
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