CATEGORY: DISEASE PREVENTION
Money worked where free medicine didn’t. In a trial of 3,220 adults who smoked daily and had been referred for a lung cancer screening scan, offering up to $600 in rewards for verified quitting roughly doubled the success rate: 8.8% were confirmed smoke-free through six months, versus 4.3% with standard advice alone.1 Handing out free quit medication without the rewards moved the rate to just 5.1%, a bump small enough to be chance.
Four offers, tested against urine and blood
Everyone in the trial got the usual care: ask, advise, refer. A computer then decided, person by person, who was also offered free medication such as nicotine patches or varenicline, who got medication plus staged cash rewards of $100, $200 and $300 for staying quit, and who got all that plus a text-message tool for imagining a smoke-free future. Claims of quitting weren’t taken on faith. Urine or blood tests did the checking at two weeks, three months and six months, and anyone who skipped a test was counted as still smoking.
Smokers nobody waits to hear from
The people enrolled are the ones quit-support programs reach least well: Black, Hispanic, rural or lower-income adults, with a median age around 61, most smoking more than ten cigarettes a day. Enrollment worked on an opt-out basis at five medical centers, so nobody had to declare themselves ready to quit before being counted in. That choice matters. It means the quit rates describe ordinary smokers facing a lung scan, not a motivated few who signed up for a quitting study. A screening referral is also a natural moment for the attempt, since the scan itself tends to put the risk in plain view.
The rewards earned their keep; the texts didn’t
Against standard care, the cash offer added 4.6 percentage points of verified quitting. Against free medication alone it added 4.1. The texting tool added nothing on top of the money, and only about one participant in eight offered rewards ever collected one. Quitting also largely stuck: most who were smoke-free at six months still were at twelve, months after the last payment. That echoes a Cochrane review of 48 reward trials in nearly 22,000 people, which found quitting about 1.5 times as likely with incentives, rated the evidence high certainty, and saw the benefit hold after the payments stopped.2
Nine in ten kept smoking anyway
Picture 100 smokers in each group. With advice alone, about four were verifiably quit at six months. With advice, free medicine and up to $600 on the table, about nine were. That’s a real doubling, and it’s also 91 people still smoking. Quitting is hard, and no single offer rescues most people from it. The authors caution that medication came without individual counseling or tailored follow-up, which may be why pills and patches alone did so little here, and the trial can’t say how the offers would land among smokers who aren’t facing a screening scan. What it can say is which lever moved. In a group medicine has struggled to reach, a modest, verified reward outperformed the standard toolkit, and since only one participant in eight ever collected a payment, the money went out only when it had already done its job.
Key Takeaways
- Cash rewards for biochemically verified quitting doubled six-month quit rates among smokers referred for lung cancer screening: 8.8% versus 4.3% with standard advice.
- Free quit medication without rewards didn’t significantly beat standard advice, though it was offered without counseling support.
- A text-message future-imagining tool added no measurable benefit on top of the financial rewards.
- The result matches a Cochrane review of 48 earlier trials, where incentives raised quitting by about half and the effect outlasted the payments.
References
- Hart JL, Vachani A, Neslund-Dudas C, et al. Smoking Cessation Among Underserved Patients Referred for Lung Cancer Screening: A Randomized Clinical Trial. JAMA. 2026; DOI 10.1001/jama.2026.17192. link
- Notley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Conde M, Hartmann-Boyce J. Incentives for smoking cessation. Cochrane Database of Systematic Reviews. 2025;(1):CD004307. link