A new study finds that employer-based programs to help people stop smoking would work better if they tapped into highly motivating feelings — such as the fear of losing money.

This conclusion flows from a study involving the employees of CVS/Caremark. Some workers got postcards asking them if they wanted a cash reward to quit smoking. One card ended up in the hands of Camelia Escarcega in Rialto, Calif., whose sister works for CVS.

Escarcega says she had smoked for many years and wanted to quit, and figured money would be a good incentive. Her sister told her she was welcome to enroll in the study, so she did.

Escarcega didn’t know it at the time, but the study was comparing different financial incentives to help people quit smoking. Hers was straightforward: Over a span of six months, she’d get up to $800 if she quit and didn’t start again.

She did pretty well, she says. “I’ve been smoke-free for a year and a half now.” The program offered her free nicotine patches, but Escarcega says she didn’t even need that added help.

Dr. Scott Halpern, a professor of medicine, epidemiology, medical ethics and health policy at the University of Pennsylvania, worked with colleagues to design the study, as a way of exploring the best way to entice people to quit tobacco, using financial incentives.

“A dollar is not a dollar,” Halpern says, “and how you design smoking cessation programs of the same approximate value goes a long way toward determining how effective these programs will be.”

The researchers compared a few approaches. Some people simply got cash for quitting. Others were offered a carrot-and-stick approach. They’d get a similar financial reward if they quit, but they’d also lose $150 of their own money if they started smoking again.

“People are much more afraid of losing $5 than they are motivated to earn $5,” Halpern says. “And so people’s actions go with their psychology.”

It came as no surprise that the researchers found it a lot harder to convince people to put down a deposit of their own money. But when they did, the results were remarkable.

“The deposit programs were twice as effective as rewards, and five times more effective than providing free smoking cessation aids like nicotine replacement therapy,” Halpern says.

More than half of the people who had money on the line stopped smoking for at least six months. These results are reported Wednesday in the latest New England Journal of Medicine. And Halpern argues the approach is much more effective than what most companies do now.

“Many programs are structured such that employees who stop smoking are rewarded by having less money taken out of their paychecks for insurance premiums the following year,” Halpern notes. “But by bundling the rewards into paychecks they’re relatively invisible to people — and the fact that they occur in the future — makes it less influential than if people were handed the same amount of money more quickly.”

Mercer, a benefits consulting company, reports that 21 percent of large employers currently offer financial incentives to workers who quit smoking or don’t start — primarily by reducing their health-insurance premiums. (An additional 5 percent of those companies offer other incentives). And more than half of the nation’s biggest employers use incentives.

Halpern says insurance premium rebates aren’t the best way to go.

“Employers and insurers could do a whole lot more to curb smoking than they currently are,” he says. “And doing so, they would reduce costs to themselves and improve public health.” Each employee who smokes costs a company more than $5,000 extra a year, due to health care costs and other expenses.

This is potentially tricky ground to navigate, though.

“Companies may have a concern that if they sign people into this kind of a wellness program and [the employees] lose that deposit, they’re going to feel really badly,” says Oleg Urminsky, at the University of Chicago’s Booth School of Business.

The worry is that those bad feelings “may spill into other things,” Urminsky says. “Are they going to resent the employer? Are they going to be complaining? It’s a powerful tool but it’s one that has to be used carefully.”

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Transcript :

MELISSA BLOCK, HOST:

Many large employers offer workers financial incentives to stop smoking. A new study finds that those programs could do a better job of tapping into human nature and get more bang for the buck. NPR’s Richard Harris looks at a new approach that motivates some smokers to quit.

RICHARD HARRIS, BYLINE: This new advice comes from a study involving the employees of CVS/Caremark, some of whom got postcards asking them if they wanted a cash reward to quit smoking. Camelia Escarcega says one came to her household in Rialto, Calif., addressed to her sister.

CAMELIA ESCARCEGA: I asked my sister, do you want this? And she said no? I said, do you mind if I use it? She said, go ahead.

HARRIS: Escarcega, who’s 55, had smoked for many years and was ready to quit.

ESCARCEGA: Money – incentive, right? (Laughter).

HARRIS: She didn’t know it at the time, but the study was comparing different financial incentives to help people quit sucking. Hers was straightforward – over a span of six months, she’d get up to $800 if she quit and didn’t start again. She stopped, and she didn’t even use the free nicotine patches that she was offered as a part of the plan.

ESCARCEGA: I did pretty good. I’ve been smoke-free for a year-and-a-half now.

HARRIS: Scott Halpern at the University of Pennsylvania and his colleagues designed this study to explore the best way to entice people to quit smoking with financial incentives.

SCOTT HALPERN: A dollar is not a dollar, and how you design smoking cessation programs of the same approximate value goes a long way toward determining how effective these programs will be.

HARRIS: Halpern’s study compared a few approaches; some like Camelia Escarcega simply got cash rewards for quitting. Other people were offered a carrot-and-stick approach. They’d get a similar financial reward if they quit, but they’d also lose $150 of their own money if they started smoking again.

HALPERN: People are much more afraid of losing $5 then they are motivated to earn $5. And so people’s actions go with their psychology.

HARRIS: No surprise, the researchers found it a lot harder to convince people to put down a deposit of their own money. But when they did, the results were remarkable.

HALPERN: The deposit programs were twice as effective as rewards and five times more effective than providing free smoking cessation aids like nicotine replacement therapy.

HARRIS: More than half of the people who had money on the line stopped smoking for at least six months. These results are reported in the latest New England Journal of Medicine. And Halpern argues it’s much more effective than what most companies do now.

HALPERN: Many programs are structured such that employees who stop smoking are rewarded by having less money taken out of their paychecks for insurance premiums the following year. But by bundling the rewards into paychecks, they’re relatively invisible to people. And the fact that they occur in the future makes them less influential than if people were handed the same amount of money more quickly.

HARRIS: Mercer, a benefits consulting company, reports that 21 percent of large employers currently offer financial incentives to non-smokers by reducing their health insurance premiums. More than half of the nation’s biggest employers use that tactic as well. Halpern says that’s not the best way to go.

HALPERN: Employers and insurers could do a whole lot more to curb smoking than they currently are. And by doing so, they would actually reduce costs to themselves and improve public health.

HARRIS: This is potentially tricky ground to navigate, though. Oleg Urminsky is at the University of Chicago’s Booth School of Business.

OLEG URMINSKY: Companies may have a concern that if they sign people into this kind of a wellness program and they lose that deposit, they’re going to feel really badly, right, which is why it works in the first place. And the worry is that that may split over into other things. Are they going to resent the employer? Are they going to be complaining? So it’s a powerful tool, but it’s also one that has to be used carefully.

HARRIS: Done right, though, everyone stands to benefit. Richard Harris, NPR News. Transcript provided by NPR, Copyright NPR.