Financial incentives can support smoking cessation, yet low acceptability may limit the wider implementation of such schemes. Few studies have examined how smokers view financial-incentive interventions aimed at reducing smoking prevalence.
We recruited a sample of 623 smokers 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 incentives.
38.4% of smokers supported financial incentives; 42.2% did not (19.4% had no opinion). 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. A Government-funded reward-only scheme was seen as the most acceptable option (preferred by 26.6% of participants), followed by a Government-funded deposit-based scheme (20.6%); few respondents supported employer-funded schemes. Open-ended responses (n=301) indicated three overarching themes expressing opposition to financial incentives: smokers’ individual responsibility for quitting, concerns about abuse of an incentive scheme, and concerns about unfairness.
Even amongst those who would benefit from schemes designed to reward smokers for quitting, support for such schemes is muted, despite evidence of their effectiveness. Media advocacy and health education could be used to increase understanding of, and support for, financial incentives for smoking cessation.
Given the absolute effectiveness and cost-effectiveness of financial-incentive schemes for smoking cessation amongst pregnant smokers and in workplaces, implementing such schemes at a national-level could help reduce overall smoking prevalence and contribute to endgame goals. Our study found that similar proportions of smokers supported and opposed financial-incentive schemes, and suggests much of the opposition was underpinned by information gaps, which could be addressed using education and media advocacy.