Rational (and quasi-rational) decision-makers weigh up the costs and benefits of their actions (as we discussed in my ECON110 class today). If the student nurses didn't give up smoking, they faced a financial penalty relative to if they had given up smoking (they missed out on the scholarship). This creates an additional opportunity cost of smoking, raising the cost of smoking. When you increase the costs of an activity, people will do less of it. So, less smoking as a result of the incentive.A couple of weeks ago, Mai Frandsen (University of Tasmania) picked up on the same issue in The Conversation, arguing in favour of paying people to stop smoking, and helpfully linking to a lot of the latest research that demonstrates that this works:
One evidence-based approach that has not received much attention in Australia is using financial incentives. Incentives programs reward quitters for not smoking by giving them a monetary voucher. The quitter’s abstinence is verified using biochemical tests of either their saliva, urine or breath...
Financial incentive programs are one of the most effective and cost effective strategies for getting people to quit. They are considered the most effective strategy for pregnant smokers. They are also cost effective, with the calculated net benefit (after taking into account of the incentives used) being around A$4,300 per smoker, per attempt to quit. There have been a number of studies showing their benefits.
Using a multinational company as a test site, a team of US researchers found people who were offered US$750 (A$938) to quit smoking were three times more successful than those who were not given any incentives. Even six months after the vouchers had stopped, previously incentivised quitters were 2.6 (21.9% vs 11.8%) times more likely to still be smoke-free compared to non-incentivised quitters.
A team of UK researchers randomised over 300 pregnant women to receive up to £400 (A$661) worth of shopping vouchers if they quit during the pregnancy. Again, women in the incentives group were 2.6 (22.5% vs 8.6%) times more likely to have stopped smoking at the end of pregnancy, compared to the women who had received counselling and nicotine replacement therapy.
A Swiss program, offering low-income smokers up to US$1,650 (A$2,063) worth of quit-contingent vouchers staggered over six months, found smokers were 1.6 (18.2% vs 11.4%) times more likely to be smoke-free at 18 months compared to non-incentivised smokers.It's past time that we gave up on outdated views about avoiding monetary incentives for promoting health behaviours. In the case of smoking, the benefits accrue to the individual who is quitting smoking, their unborn children, their families, and to the community that doesn't face covering the healthcare costs associated with smoking. If we're looking for cost-effective ways to improve health, this should be high on the list.