Much has been made about a recent study that claims giving people $600 dollars and then threatening to take it away from them if they don’t quit, is more effective than offering free e-cigarettes.

On the surface it looks like a no brainer… $600 bucks is one hell of an incentive.

But is it true?

This new study, with very good numbers – 6006 participants in all, studied how incentivized people were to quit smoking, with different types of support and encouragement.

Before we get into the nuts and bolts of the study though, let’s look at some of the methodology.

Firstly, the people had to opt out if they didn’t want to participate. They were chosen by the companies they worked for and were told – do it. This means not everyone in the study was motivated to stop smoking, and not everyone wanted to stop smoking. Only 1191 involved were considered engaged.

(We all know motivation is a must if you are to change any habit.)

Secondly, the offer of free cigarettes consisted of simple re chargeable e-cigarettes, with only 20 free refills a week. The nicotine levels on offer were 1 – 1.5%.

For people transitioning away from smoking, that nicotine level is not high enough.  

Using simple devices with low nicotine levels tends not to work for long term, heavy, and probably unmotivated smokers.

In this study  e-cigarettes were fighting with one hand behind their back before it even started.  When people study e-cigarettes it would be advisable if they could ask people that know about e cigarettes to inform them, and that way gain meaningful results.  

 

The 6006 smokers in the study were randomly put into 5 groups.

  • Usual care that consisted of information and text message support. (control group)

Usual care plus one of the following:

  • free cessation aids (nicotine-replacement therapy or pharmacotherapy, with e-cigarettes if standard therapies failed).
  • free e-cigarettes, without a requirement that standard therapies had been tried.
  • free cessation aids plus $600 in rewards for sustained abstinence.
  • free cessation aids plus $600 in redeemable funds, deposited in a separate account for each participant, with money removed from the account if cessation milestones were not met.

“The primary outcome was sustained smoking abstinence for 6 months after the target quit date.”

 

It doesn’t seem at all surprising that $600 in the bank wins. It is tangible, it is there, and it is a goal to work towards. Not only will you quit smoking, save money along the way, but you also get a reward.

 

But what about the people that were given $600 anyway? Why wasn’t that enough? It’s because of the way we are psychologically wired. We see loss as more motivating.

 

The researchers feel that the loss method could possibly be the way forward, as not only was it more successful, it was also cheaper:

 “Nonetheless, the observation that framing the incentives as already earned and at risk of being lost (loss framing) produced nominally higher rates of quitting at nominally lower costs per quit, and this may motivate employers who are planning incentive programs to consider the use of loss framing.”

This ‘psyops’ technique of loss framing would probably work in many scenarios, not simply quit smoking.

12.7 % of those in the loss framing group were successful.

Yet, when we zoom out and look at the entire study, in total: “Among 6,006 employees at 54 U.S.-based companies, the six-month smoking abstinence rates for all the strategies were less than 3 percent.”

Here comes the kicker though….

The media are spinning this into saying e-cigarettes don’t help you get off the tobacco.

Here are two of the many headlines about this study:

“E-cigarettes do not effectively help people quit smoking: Study”

“MONEY A BETTER MOTIVATOR TO STOP SMOKING THAN FREE E-CIGS OR QUIT AIDS”

Instead of stating that usual care doesn’t work, with only a 1% success rate in that group, NRT not much better, coming in at 2.9% quit rate, and simple e-cigs with not enough nicotine only slighter better again with a 4.8% quit rate – no, we get e cigarettes don’t work.

Study co-author Dr. Scott Halpern of the University of Pennsylvania told Reuters that his data shows that e-cigarettes really aren't that helpful for people who want to stop smoking.

"We cannot detect any evidence that they are better than offering free conventional smoking cessation aids or just providing information,” he said.  The statistical difference between e cigarettes and other NRT was so small, it was not considered significant.

Yet we know e-cigarettes do work.

The reason that vaping works is because people are self-motivated when they decide to switch. Remember, many in this trial were not motivated.

Vaping also works because you tailor your vape requirements, to your needs.

Being given a simple e-cigarette with nicotine that is way less than you need sets people up for failure. Only 4.8% of people using free e cigarettes quit completely and remained smoke free after 6 months. How much higher would this statistic be if they had been given a voucher – told to go down to their local vape shop – were set up with what they needed – and then started the study?

Which leads us to question the interpretation and spin put on the study.

This study could be an incredible opportunity for all in tobacco control and the FDA to truly see how poor the current NRT paradigm is. It clearly highlights that the current ‘usual methods’ don’t work.  

Going cold turkey / NRT and text messaging are not helping people to get away from tobacco.

Why is that not the screaming headline?

NRT fails a lot of people, a lot of the time.

E cigarettes, when given the chance, help a lot of the people a lot of the time. As the National Health Service in the UK plainly state:

“There is growing evidence that e-cigarettes can help people stop smoking. Using an e-cigarette can help you manage your nicotine cravings. To get the best out of it, make sure you're using it as much as you need to and with the right strength of nicotine in your e-liquid.”