UF Study: Testing Shopping Vouchers To Help Smokers Kick The Habit

January 14, 2004

GAINESVILLE, Fla. — Smokers who have already blown their New Year’s resolutions to kick the habit may find hope in a new approach that rewards them with shopping sprees if they shun cigarettes.

In a small clinical trial, University of Florida psychology Professor Jesse Dallery is rewarding smokers with vouchers to buy products online at Target, Wal-Mart, Amazon.com, Blockbuster and 17 other vendors if they prove they can stay clean by passing home-based breath tests connected to their personal computers.

Although vouchers have been a part of smoking cessation programs in the past, this is the first time home-based video monitoring systems have been used to measure results and verify the identity of the person providing the breath sample, said Dallery, who is conducting the two-year study with a $200,000 grant from the National Institutes of Health. He hopes to duplicate among smokers the success he achieved among cocaine and heroine addicts in a study he did at Johns Hopkins University.

Pay is “a powerful incentive because it provides immediate results,” Dallery said. “Smokers don’t have to wait years and years to experience the benefits of quitting.”

More than 48 million people smoke in the United States. As many as one-fifth of all deaths from heart disease are attributable to smoking, and it is also blamed for an estimated $50 billion per year in health-care expenses, Dallery said.

In the small clinical trial among three participants that began six months ago, one man has kicked the habit entirely. Another, who started at age 7 and had smoked more than 30 cigarettes a day for 15 years, reduced his smoking by 75 percent, and the third cut in half the number of cigarettes he smoked, Dallery said.

“We would say that they are tobacco free if they are abstinent for about two weeks. This is a key period,” Dallery said, as research shows early success predicts long-term victory in kicking the habit.

The participants were recruited from newspaper ads and flyers posted in the Gainesville area. One person signed up but moved out of state and another didn’t smoke enough, so they did not participate in the study. Dallery is now expanding the research by trying it on 10 men and 10 women.

The sample size “is smaller than most clinical trials because our research design is different, and because of the relative strength, or effectiveness, of the intervention,” he said.

The idea to pay people for quitting grew out of a similar program that Dallery tried in 2000 with drug addicts as a postdoctoral fellow at Johns Hopkins University. Participants who passed urinalysis tests showing they had abstained from using cocaine or heroin were rewarded with cash vouchers.

“They (addicts) were pretty down and out – many faced eviction – and they could use the money to pay for groceries, their electric bill or for rent,” he said. “One man saved enough money in voucher money to buy a car. It was a cheap car, but it was very motivating.”

As with the drug experiments, participants in the smoking study are rewarded with bonuses and escalating dollar amounts the longer they abstain. Participants receive $2.50 for the first successful breath test, with the payoff escalating by $1 on average for each consecutive smoke-free test. For those who fall off the wagon, the amount falls back to the previous level. Four successive abstinence-free tests nets a $5 bonus, Dallery said.

Once participants have saved enough voucher money for desired products, they submit order forms to Dallery, who buys the items and arranges to have them shipped to them. The three current participants have earned between $50 and $125 in vouchers, he said.

To track their progress, Dallery lends each participant a carbon monoxide monitor that works like a Breathalyzer but calculates the amount of carbon monoxide in the lungs instead of the level of alcohol in the blood. Carbon monoxide remains in the lungs for about 12 hours after a cigarette.

In order to be sure it is the participant who is taking the breath test and not a non-smoking stand-in, the machine is hooked up to a webcam on the partipants’ personal computers and once the test is done, they must e-mail a video clip of the process to Dallery.

Earlier studies relied on tests done in clinics, where it was relatively easy to smoke a cigarette afterward and not have the results show up when the next test was given several days later, he said.

Stephen Higgins, a professor of psychiatry and psychology at the University of Vermont who developed voucher-based incentives as a strategy to treat cocaine dependence in outpatient settings, said Dallery’s research is an important contribution.

“Voucher-based incentives represent an innovative and often very effective method for helping dependent individuals abstain from substance use,” he said. “Dr. Dallery’s efforts to apply the intervention with cigarette smokers in a manner that doesn’t require them to attend a clinic is very interesting, creative and potentially important to the dissemination of this treatment innovation.”

Despite the small number of participants, Dallery said, the study shows the approach can produce valid results. And while the treatment is expensive, tobacco settlement money and other grants may be available to defray some of the costs, he said.

“If a smoker is smoking at a high rate and we reduce it to nothing and replicate that 20 times with 20 individuals, then we can be pretty confident the treatment works,” he said. “Our hope is that the few smokers will be high-risk smokers, such as pregnant women, those suffering from tobacco-related disease and so-called hard-core smokers. These smokers represent a disproportionate amount in terms of health-care costs and illness.”