![]() Pregnancy trials: Combining data from nine trials showed that women in the rewards groups were more likely to stop smoking than those in the control groups, both at the end of the pregnancy and after the birth of the baby. There was no noticeable difference between trials paying smaller amounts (less than USD 100 (US dollars)) compared to those paying larger amounts (more than USD 700). Studies varied in the total amounts of rewards that were paid. Success rates continued beyond when the incentives had ended. General trials: Six months or more after the beginning of the trial, people receiving rewards were more likely to have stopped smoking than those in the control groups. Rewards were vouchers that were sometimes increased in value, depending on how long the woman had managed to stay quit. We found ten trials, nine based in the USA and one in the UK, covering 2571 pregnant women who smoked. ![]() Pregnancy trials: We looked at studies in pregnant women separately. Rewards were cash payments, vouchers, or the return of money deposited by those taking part. Those who had quit were checked by testing their breath or bodily fluids. All the trials followed up participants for at least six months. Twenty‐four of the trials were run in the USA. Two studies included smokers from mental health clinics, two from primary care clinics, two from head‐and‐neck cancer treatment clinics, two from colleges or universities, and one in Thai villages. General trials: We found 33 trials, covering more than 21,600 people, that tested different rewards schemes to help smokers to quit. We conducted our most recent search for studies in July 2018. Such schemes can be run in workplaces, in clinics, and sometimes as community programmes. ![]() Rewards, such as money or vouchers, can be used to encourage smokers to quit, and to reward them if they stay stopped. Quitting smoking can greatly improve people's health. Most smokers want to quit, but stopping smoking can be very challenging. Smoking is the leading cause of disease and death worldwide. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69 N = 2273 I 2 = 41%), in favour of incentives.Ĭan rewards help smokers to quit in the long term? We judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. We included 10 studies of 2571 pregnant women. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits. Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69 25 RCTs adjusted N = 17,058 I 2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease.Īlthough not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73 31 RCTs, adjusted N = 20,097 I 2 = 33%). Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. ![]() Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. Thirty‐three mixed‐population studies met our inclusion criteria, covering more than 21,600 participants 16 of these are new to this version of the review.
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