四项戒烟经济激励方案的随机试验。
Randomized trial of four financial-incentive programs for smoking cessation.
作者信息
Halpern Scott D, French Benjamin, Small Dylan S, Saulsgiver Kathryn, Harhay Michael O, Audrain-McGovern Janet, Loewenstein George, Brennan Troyen A, Asch David A, Volpp Kevin G
机构信息
From the Departments of Medicine (S.D.H., D.A.A., K.G.V.), Biostatistics and Epidemiology (S.D.H., B.F., K.S., M.O.H.), Medical Ethics and Health Policy (S.D.H., K.G.V.), and Psychiatry (J.A.-M.) and the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of Health Economics (S.D.H., B.F., D.S.S., K.S., J.A.-M., G.L., D.A.A., K.G.V.), Perelman School of Medicine at the University of Pennsylvania, the Departments of Statistics (D.S.S.) and Health Care Management (D.A.A., K.G.V.), Wharton School, University of Pennsylvania Center for Health Equity Research and Promotion, the Philadelphia Veterans Affairs Medical Center (D.A.A., K.G.V.), and the Center for Health Care Innovation, University of Pennsylvania Health System (D.A.A., K.G.V.) - all in Philadelphia; the Center for Behavioral Decision Research, Carnegie Mellon University, Pittsburgh (G.L.); and CVS Caremark, Woonsocket, RI (T.A.B.).
出版信息
N Engl J Med. 2015 May 28;372(22):2108-17. doi: 10.1056/NEJMoa1414293. Epub 2015 May 13.
BACKGROUND
Financial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain.
METHODS
We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids.
RESULTS
Overall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P=0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program.
CONCLUSIONS
Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs. (Funded by the National Institutes of Health and CVS Caremark; ClinicalTrials.gov number, NCT01526265.).
背景
经济激励措施能促进多种健康行为，但提供健康激励的有效方式仍不明确。
方法
我们将CVS Caremark公司的员工及其亲友随机分配到四个激励项目之一或接受戒烟常规护理。其中两个激励项目针对个人，另外两个针对每组六名参与者的小组。一个针对个人的项目和一个针对小组的项目对成功戒烟者给予约800美元的奖励；其他项目要求参与者缴纳150美元的可退还押金，若成功戒烟则额外支付650美元奖励金。常规护理包括信息资源和免费戒烟辅助工具。
结果
总共招募了2538名参与者。在被分配到基于奖励项目的参与者中，90.0%接受了分配，而被分配到基于押金项目的参与者中这一比例为13.7%（P<0.001）。在意向性分析中，四个激励项目中每个项目的6个月持续戒烟率（范围为9.4%至16.0%）均高于常规护理（6.0%）（所有比较P<0.05）；基于奖励项目的优势持续到12个月。面向小组和面向个人的项目6个月戒烟率相似（分别为13.7%和12.1%；P=0.29）。基于奖励的项目比基于押金的项目戒烟率更高（15.7%对10.2%，P<0.001）。然而，在考虑不同接受情况的工具变量分析中，在估计会接受两种项目中任一项目参与的13.7%的参与者中，基于押金的项目6个月戒烟率比基于奖励的项目高13.2个百分点（95%置信区间，3.1至22.8）。
结论
基于奖励的项目比基于押金的项目更常被接受，从而导致更高的持续戒烟率。面向小组的激励项目并不比面向个人的项目更有效。（由美国国立卫生研究院和CVS Caremark资助；ClinicalTrials.gov编号，NCT01526265。）
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