Should we pay all smokers to quit smoking? A mixed methods survey exploring New Zealand smokers' perceptions of financial incentives

Abstract

Background: Evidence suggests financial incentives can support smoking cessation among pregnant smokers and for employees in a workplace setting, yet low acceptability may limit the wider implementation of such schemes. The increasing adoption of endgame goals by numerous countries indicates a need for new and potentially controversial strategies that could bring about rapid declines in smoking prevalence. Limited research has examined how smokers themselves view the idea of financial incentive interventions for which the general population of smokers would be eligible. Methods: A sample of 623 smokers was recruited from an internet panel to a survey assessing support for, and perceived effectiveness of, financial incentives for smoking cessation. We used descriptive statistics, plus logistic regression, to test associations between demographics and smoking, and support. We used qualitative content analysis to analyse open-ended responses to a question that invited respondents to comment on financial incentive schemes. Results: Thirty-eight percent of smokers supported financial incentives to quit smoking; 42% did not. Support was higher among heavy (OR 3.96, CI 2.39 - 6.58) and moderate smokers (OR 1.68, CI 1.13 - 2.49), and those with a recent quit attempt (OR 1.47, 1.04 - 2.07). Support was strongly associated with perceived effectiveness. Of those who did not oppose financial incentives: 45% preferred a Government-funded reward-only scheme, while 35% preferred a Government-funded deposit-based scheme; few respondents supported employer-funded schemes. Openended responses (n=301) indicated three overarching themes in relation to opposition to financial incentives: smokers' individual responsibility for quitting, concerns about abuse of an incentive scheme, and concerns about unfairness. Conclusions: Financial incentive schemes designed to reward smokers for quitting create controversy and attract low public support, despite growing evidence of their effectiveness. Media advocacy and health education could be used to increase public understanding of, and support for, financial incentives for smoking cessation.