Quitting smoking is incredibly hard. Penn researchers find one thing that helps most

Hey, employers, want your workers to snuff out the butts? Try coughing up the bucks.

That's the bottom line of a new study by researchers with Penn's Perelman School of Medicine.

Offering employees financial incentives to quit, along with such stop-smoking aids as nicotine gum and patches or medication at no charge, proved to be three times as effective as providing smoking cessation products alone, according to results of the study, published in the New England Journal of Medicine.

And if you're thinking about offering your smoking workforce free e-cigarettes in hopes they'll give up the old-school kind, you might want to reconsider. The researchers found that route to be no more successful than traditional quitting aids.

These latest findings agree with earlier studies: If you want to get people to quit smoking, show them the money.

"The new study drives forward previous research by showing that even among smokers who are cherry-picked on the basis of their motivation to quit, financial incentives still triple quit rates, whereas offering free conventional cessation aid or free e-cigarettes accomplishes nothing at all," said lead author Scott D. Halpern, an associate professor and steering committee member of Penn's Center For Health Incentives and Behavioral Economics (CHIBE).

Another point the study underscores: Quitting is incredibly tough. Even in the best outcome group, the 6-month abstention rate averaged 2.9 percent, rising to 12.7 percent for the most engaged participants.  The journal article notes that past studies saw quit rates of 15 percent to 16 percent.

All in all, those results are not so different from beating opioid-use disorder. Research says people quitting opioids have an  80 percent to 90 percent chance of relapse a month after detox, unless they use medication-assisted treatment, such as methadone or Suboxone. With such medicine, some treatment experts say they see a retention rate of about 50 percent six months after detox – better results than the smokers had.

The new Penn study enrolled more than 6,000 people from 54 U.S.-based companies. Of those, nearly 1,200 accessed the trial's website at least once. Those participants were four to six times more likely to stay smoke-free for six months after their quit date than the other people in the study, the researchers found.

All participants were separated into five groups: One was given information about the benefits of quitting and motivational texts; another had free aids such as nicotine patches, gum and medicine; the third received free e-cigarettes; the fourth had free cessation aids and the promise of $600 if they didn't smoke; and the last group got free anti-smoking aids and $600 put in an account opened for them that they would get access to if they stayed smoke free.

One key finding was that the most common strategy used by employers — providing them with free access to such quit-smoking aids as nicotine gum or patches — is expensive, but works no better than just giving them information on the benefits of quitting.

It makes more sense to invest in financial rewards for quitting, the study found.

"One of the key virtues of incentive programs is that they only cost money if people succeed in changing their behavior," said senior study author Kevin Volpp, CHIBE director. "By contrast, employers that offer free cessation aids to their employees are paying money whether or not the aids help the smokers quit."

The kind of incentive program, however, makes a difference. The Penn researchers found that people respond more if they're made to feel that they have some skin in the game. Those who were told that money was already in an account in their name — but that they had to stay smoke-free to get it — did a little better than those who were just told they would get money.

The finding echoes a study Halpern and his colleagues conducted three years ago, when they compared two groups that would get the same financial reward for quitting. But one group also had to put in some of their own money, which they stood to forfeit if they failed. That second group was more successful.

"Economically, those are flip sides of the same coin, but we are much more averse to potential losses than we are excited about the potential of equally sized gain," Halpern explained. "By making people feel they have something at risk, we might do better to motivate behavior change."