Should we pay all smokers to quit smoking? A mixed methods survey exploring New Zealand smokers' perceptions of financial incentives

摘要

Background Evidence suggests financial incentives can support smoking cessation among pregnant smokersand for employees in a workplace setting, yet low acceptability may limit the widerimplementation of such schemes. Theincreasing adoption of endgame goals by numerous countries indicates a need fornew and potentially controversial strategies that could bring about rapiddeclines in smoking prevalence. Limited research hasexamined how smokers themselves view the idea of financial incentive interventionsfor which the general population of smokers would be eligible.Methods A sample of 623 smokers was recruited from an internetpanel toa survey assessing support for, and perceived effectiveness of, financial incentivesfor smoking cessation. We used descriptive statistics, plus logistic regression,to test associations between demographics and smoking, and support. We used qualitative content analysis toanalyse open-ended responses to a question that invited respondents to commenton financial incentive schemes.Results Thirty-eight percent of smokers supported financialincentives to quit smoking; 42% did not. Support was higher among heavy (OR 3.96, CI2.39 - 6.58) and moderate smokers (OR 1.68, CI 1.13 - 2.49), and those with a recentquit attempt (OR 1.47, 1.04 - 2.07). Support was strongly associated with perceived effectiveness. Of those who did not oppose financialincentives: 45% preferred a Government-funded reward-only scheme, while 35% preferreda Government-funded deposit-based scheme; few respondents supportedemployer-funded schemes. Open-ended responses (n=301) indicated three overarchingthemes in relation to opposition to financial incentives: smokers' individualresponsibility for quitting, concerns about abuse of an incentive scheme, and concernsabout unfairness.Conclusions Financial incentive schemes designed to reward smokersfor quitting create controversy and attract low public support, despite growingevidence of their effectiveness. Mediaadvocacy and health education could be used to increase public understandingof, and support for, financial incentives for smoking cessation.