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A pragmatic trial of e-cigarettes, incentives, and drugs for smoking cessation

Scott D Halpern, Michael O Harhay, Kathryn Saulsgiver, et al.
N Engl J Med 2018;378:2302–10.
doi: 10.1056/NEJMsa1715757

Smoking is the leading cause of preventable illness and death. Companies in the US offer employees smoking cessation programmes to alleviate the cost associated with smoking. Understanding the most effective intervention for smoking cessation can guide companies on how to support smoking cessation with their employees.

This pragmatic trial of smoking cessation aimed to explore the effectiveness of five smoking cessation interventions. These interventions included usual, free cessation aids (including nicotine replacement therapy or pharmacotherapy, or access to free e-cigarettes if these therapies failed), free e-cigarettes, free cessation aids plus a $600 reward or free cessation aids plus $600 in redeemable funds, provided as a deposit with money removed if cessation milestones were not met.

Results showed that the $600 incentive group demonstrated the highest sustained abstinence rate at six months (2.9%), with the reward group coming as a close second (2.0%). Usual care, free cessation aids and free e-cigarettes produced sustained abstinence rates of 0.1%, 0.5% and 1.0%, respectively.

Researchers concluded that financial incentives, when used in combination with free cessation aids, were the most effective smoking cessation intervention. Although these results are compelling, it is important to remember that interventions used in each group were not distinct from each other. Therefore, it may be hard to draw clear conclusions about the most effective method of smoking cessation based on these results.

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