Last Tuesday Andre Picard, the health columnist for the Globe and Mail, urged governments to take drastic steps to eliminate cigarettes. He presents compelling ideas but, sadly, most of them are not likely to be implemented any time soon. In the meantime a study recently published in the New England Journal of Medicine addresses an interesting, incremental way to motivate people to butt out: you pay them.
In a previous post I've written about both the public and private sector rewarding people for healthy living, including in terms of being more physically active and eating/drinking more nutritiously. In terms of the former think of the Children's Fitness Tax Credit that provides a voucher through the tax system to promote physical activity for kids. In terms of the latter think of the Healthy Incentives Pilot (HIP) in the U.S. that is using SNAP (food stamps) to provide financial incentives for recipients to eat more nutritiously.
These initiatives are often viewed as part of the turning to "nudges" (also dealt with in a previous post) to promote various policies: incentives that shape individuals' behaviour in predictable ways without foreclosing options or substantially modifying economic incentives. Paying people to quit may, at first, seem far fetched. But it is part of a larger movement to implement what are regarded as sound policies without invoking the heavy hand of the state: regulating lite.
The study in question offered a large group of employees the choice of joining two different programs aimed at encouraging them to quit smoking. They were employees of CVS, the pharmacy chain, which stopped selling tobacco products in 2014 and which supported the research. They could either have the benefit of an $800 reward if they quit and did not start again for six months (the pure reward option) or be threatened with losing a $150 deposit and not receiving a reward of $650 if they resumed smoking within six months (the penalty option).
We'll get to the different results of these two options in a moment. But, for starters, it's important to note that both these options produced better quitting results than therapy or weaning substitutes for nicotine such as gum or patches.
Those who choose the penalty option had a higher success rate than the pure reward option (50 per cent versus 17 per cent). So in that sense sticks seem to work more effectively than carrots. So we shouldn't by any means rule out the potential of penalties to influence behaviour. However, far more individuals opted for the pure reward option than did those who choose the penalty alternative (90 per cent versus 13.7 per cent). So, overall, the pure reward option led to more individuals quitting smoking for the requisite period.
There are a number of implications from these results. Penalties do have a role in modifying people's actions. However, significantly more people would seem to be motivated by the prospect of a reward. In addition, the study only followed participants for a relatively short period of time. Long term impact can only be ascertained by a studies of much longer duration. Lastly, altering the amounts of the rewards and the penalties might produce different rates of success shorter and longer term.
But the main point is that both the private and public sector should be open to more of these experiments in a variety of areas where policy objectives are sought to be furthered. Rewards have costs associated with them. But, in the case of smoking, the health benefits achieved can greatly exceed such costs should individuals stop permanently. These strategies will often have to proceed by trial and error. There's lots of potential for regulation lite but a fair bit of experimenting is necessary to establish where and under what conditions it has traction.
Back to Picard. His call to arms against the tobacco companies is inspiring. Such ambitious agendas need champions. But their realization lies in the distance. Meanwhile further, incremental progress can be made. Butting out as, quite literally, a rewarding experience may point the way.
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