Tobacco Use: Incentives and Competitions to Increase Smoking Cessation Among Workers – When Used Alone – Inactive

The CPSTF finding is based on evidence from a systematic review which identified only one study (search period January 1980 March 2005).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.

More details about study results are available in the CPSTF Finding and Rationale Statement.

The systematic review identified one study.

• Over a 12-month intervention period, 32.8% of the baseline participants continuously abstained from using tobacco.
• Verified cessation rates were 49% at six months and 36% at 12 months into the contest period.

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• Are there settings where worksite-based incentives or competitions when implemented alone are effective?
• Would it make a difference if incentives or rewards were offered for things other than tobacco cessation (e.g., for achieving personal health goals)?

• The one study from Sweden evaluated a worksite-based tobacco cessation contest with a precontest promotion, an enrollment period, biochemical verif cation of self-reported abstinence at each assessment, and three lottery drawings over a 12-month intervention period (at one, 6, and 12 months).
• 10% of tobacco-using workers participated in the intervention.

Leeks KD, Hopkins DP, Soler RE, Aten A, Chattopadhyay SK, Task Force on Community Services. Worksite-based incentives and competitions to reduce tobacco use: a systematic review. American Journal of Preventive Medicine 2010;38(2S):263-274.

Task Force on Community Services. Recommendations for worksite-based interventions to improve workers’ health. American Journal of Preventive Medicine 2010;38(2S):232-236.

Effectiveness Review

Analytic Framework – See Figure 1 on page S265

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table — Effectiveness Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Sloan RP, Dimberg L, Welkowitz LA, Kristiansen MA. Cessation and relapse in a year-long workplace quit-smoking contest. Prev Med 1990;19(4):414-23.

The following outlines the search strategy for incentives and competitions to increase smoking cessation among workers, when used alone or in combination with other interventions.

Effectiveness Review

The articles to be reviewed were obtained from systematic searches of multiple databases, reviews of bibliographic reference lists, and consultations with experts in the field. The following databases were searched for the period January 1980 March 2005: Medline, PsycINFO, EMBASE, and the database of the CDC’s Office on Smoking and Health. The keywords used for the search were health behavior, health education, primary prevention, work, workplace, occupational health, smoke, tobacco, air pollution, indoor, tobacco smoke pollution, smoking cessation, insurance coverage, nicotine dependence treatment, motivation, incentives, compete, competition, and contest. Other relevant sources were identified from the bibliographies of pertinent articles.

Database: Ovid MEDLINE(R)

1. exp health behavior/ (22792)
2. exp health education/ (30978)
3. health promotion/(12410)
4. exp primary prevention/ (23463)
5. 1 or 2 or 3 or 4 (82228)
6. exp work/(2185)
7. workplace/(3661)
8. occupational health/ (7101)
9. 6 or 7 or 8 (11786)
10. (smok$ or tobacco).mp. [mp=title, original title, abstract, name of substance, mesh subject heading] (58152)
11. 5 and 9 and 10 (132)
12. air pollution, indoor/lj (44)
13. smoking/lj or tobacco smoke pollution/lj (911)
14. smoking cessation/ and insurance coverage/(27)
15. smoking cessation/ and nicotine dependence treatment$.mp. [mp=title, original title, abstract, name of substance, mesh subject heading] (12)
16. 12 or 13 or 14 or 15 (977)
17. 11 or 16 (1100)
18. limit 17 to (english language and yr=2002 – 2004) (315)
19. limit 18 to “review articles” (38)
20. from 19 keep 1-38 (38)
21. 21 18 not 19 (277)

Database: EMBASE

1. (smok$ or tobacco).mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (52779)
2. Health Behavior/ (6295)
3. health promotion/ (11391)
4. health care psychology.mp. or health education/ [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (10276)
5. prevention/ or health screening/(5934)
6. 2 or 3 or 4 or 5 (30601)
7. exp occupational health/ (34897)
8. exp workplace/ (5259)
9. 7 or 8 (37311)
10. 1 and 6 and 9 (220)
11. indoor air pollution/ and (polic$ or law$ or ordinance$).mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (73)
12. smoking/ and ((ban$ or restriction$).mp. or pollution/ or passive smoking/) [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (831)
13. smoking cessation/ and insurance/ (4)
14. smoking cessation/ and nicotine dependence treatment$.mp. [mp=title, abstract, subject headings, drug trade name, original title, device manufacturer, drug manufacturer name] (18)
15. 11 or 12 or 13 or 14 (920)
16. 10 or 15 (1126)
17. limit 16 to (english language and yr=2002 – 2004) (412)
18. limit 17 to “review” (65)
19. from 18 keep 1-65 (65)
20. 17 not 18 (347)
21. from 20 keep 1-347 (347)

Database: PsycINFO

1. health behavior/(2320)
2. exp health care psychology/(913)
3. exp health education/(1449)
4. health promotion/(1688)
5. exp prevention/(6047)
6. exp health screening/(1003)
7. 1 or 2 or 3 or 4 or 5 or 6 (11545)
8. work$.hw. (6748)
9. 7 and 8 (206)
10. (smok$ or tobacco).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (5334)
11. 9 and 10 (18)
12. (indoor air and (polic$ or law$ or ordinance$)).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (4)
13. tobacco smoking/and (ban$ or restriction$).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (121)
14. (second-hand smoke or passive smoking).mp. [mp=title, abstract, subject headings, table of contents, key concepts] (37)
15. smoking cessation/and health insurance/(5)
16. smoking cessation/and nicotine dependence treatment$.mp. [mp=title, abstract, subject headings, table of contents, key concepts] (2)
17. 12 or 13 or 14 or 15 or 16 (162)
18. 11 or 17 (180)
19. limit 18 to (english language and yr=2002 – 2004) (123)
20. 20 limit 19 to “1300 literature review” (8)
21. from 20 keep 1-8 (8)
22. 19 not 20 (115)
23. from 22 keep 1-115 (115)

CDP Search Criteria- Smoking and Health Database

Descriptors: (“health behaviors” or “health education” or “health promotion” or “prevention of smoking”) and (work*) and
(smok* or tobacco*) and
Publication Year: 2002 To 2004

Descriptors: “indoor air pollution” or “tobacco pollution” and
Textwords: polic* or law* or ordinance* and
Publication Year: 2002 To 2004

Descriptors: “smoking cessation” and
Textwords: insurance or nicotine adj dependence adj treatment* and
Publication Year: 2002 To 2004

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.