Smoking cigarettes is horrible for your health, there’s no denying that. Yet, people continue to do it, as is their right, just like it is their right to continue other destructive or unhealthy behaviors, like drinking to excess, or even having a troubled relationship with food. As Americans, we don’t like to be told what to do — and that includes our bad habits. But we’re coming to the fast and hard realization that smoking doesn’t just take a toll on our own, individual health, it costs everyone, even the entire economy, billions of dollars per year.
Knowing that all of us have some skin in the game when it comes to smoking, there is a clear and obvious incentive for even non-smokers to want smoking rates to decline. The problem is, again, that we really have no authority to tell others how to live their lives, even if it does end up costing us in the end.
One way to pull ourselves out of this pickle was recommended by researchers from the University of Pennsylvania, and is pretty genius in its simplicity. The study, which was published in the New England Journal of Medicine, calls for us to pay smokers to quit. The logic is that if we want to incentivize people to give up their cigarettes, we should use the most simple and attractive medium that we can: cash.
To reach that conclusion, researchers examined a handful of different incentive models with more than 2,500 participants, all of whom were employees of CVS Caremark or their relatives and friends, with household incomes of less than $60,000. The models varied from a gambling-like system, in which participants would lose their money if they didn’t make lifestyle changes, to different reward systems, and a system in which people were simply paid to quit.
The winning system was the one that handed $800 to those who successfully quit smoking, which reinforced another study involving 878 General Electric employees, the results of which were published in 2009.
“Individual rewards of $800, as compared with usual care, nearly tripled the rate of smoking cessation among CVS Caremark employees and their friends and family confirms and extends the generalizability of our finding from a previous trial involving General Electric employees,” the researchers write. As an incentive to employers who may scoff at the idea of paying employees to kick their smoking habits, the researchers say that an incentive program could save them big bucks in terms of lost productivity and health issues.
“Because employing a smoker is estimated to cost $5,816 more each year than employing a nonsmoker, even an $800 payment borne entirely by employers and paid only to those who quit would be highly cost-saving,” the study goes on to say. Those costs include lost productivity from absenteeism, smoke breaks, and additional health costs.
It’s an interesting conclusion, to say the least, but there are some issues with the incentive plan. Depending on several factors, including income level and willingness or eagerness to quit, other methods besides just handing over cash were more useful. One other thing to take into account is the fact that smoking rates have been on the decline for some time now, and employers may not be willing to commit funding to fix a problem that is solving itself with time.
The most recent numbers available from the Centers for Disease Control say that the current U.S. smoking rate is down to 17.8%, which adds up to more than 42 million Americans. That may seem high, but it’s an incredible reduction from the 1940s and 1950s, when as many as 44% of Americans reported themselves as smokers, according to Gallup. Despite the decline, cigarettes still account for nearly half a million deaths per year.
With tens of millions of Americans still sucking ash, and causing up to $278 billion per year in economic damages as a result, it’s clear that employers, and everyone else, have a vested interest in seeing the smoking rate decline even further. In 21 states, employers can legally discriminate against smokers — which they have an incentive to do, since smokers end up being a more expensive investment. But even that is still on shaky ground, considering that an individual’s habits are more or less their own business.
There’s definitely reason to be skeptical as well, as it’s unclear how these systems could actually work when implemented. Would smokers just turn around and pick up the habit again after the bonus cash stops. Or, even fake the habit to scam employers. But we should remember that this study is merely a starting point, and the there’s a long way to go before a solid system is devised.
The way to keep stamping out America’s smoking problems may be to fork over some cash, as we’re learning. It may be a crazy idea to some, but cash incentives get people’s attention, and as research shows, they seem to work.
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