Cash Incentives to Quit Smoking About Doubled Quit Rates in a Large Trial
Updated: 3 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Cash incentives to quit smoking about doubled quit rates in a large randomized trial. Among more than 3,200 adults who smoked and were referred for lung cancer screening, up to $600 in rewards plus free quit-smoking medicines raised verified six-month quit rates to 8.8%, compared with 4.3% for usual care. Most people still did not quit [1].
Do cash incentives to quit smoking actually work? A large new randomized trial says yes, at least for six months. Among more than 3,200 adults who smoked and had been referred for lung cancer screening, offering up to $600 in cash rewards for staying smoke-free, on top of free quit-smoking medicines, raised verified quit rates to 8.8%, compared with 4.3% for usual care. That is roughly double. But most people still did not quit, so cash works best as one tool among several, not a magic fix (Hart et al., JAMA, 2026) [1].
What the research says
Cash rewards help people quit across many trials. A Cochrane review pooled 31 randomized trials (adjusted total of 20,097 people) and found that incentives raised long-term quit rates by about 49% compared with no incentives (risk ratio 1.49). The benefit was still seen when studies that kept paying at the final check-up were left out, which suggests the effect lasts for at least some time after payments stop (Notley et al., Cochrane Database of Systematic Reviews, 2019) [2].
Simple reward programs are the ones people sign up for. In a trial of 2,538 employees and their friends and relatives, every one of four incentive programs beat usual care, with six-month quit rates of 9.4% to 16.0% versus 6.0%. Programs that simply paid rewards were accepted by 90.0% of people, while programs that first asked people to put down their own deposit were accepted by only 13.7% (Halpern et al., New England Journal of Medicine, 2015) [3].
Nicotine replacement still matters. A Cochrane review of 133 trials with 64,640 participants found that nicotine replacement products (patches, gum, lozenges, sprays and inhalers) raised the chance of quitting by 50% to 60% compared with placebo or no nicotine replacement (Hartmann-Boyce et al., Cochrane Database of Systematic Reviews, 2018) [4].
Key takeaways
In a 3,220-person randomized trial, cash incentives to quit smoking (up to $600) plus free medicines raised verified six-month quit rates to 8.8%, versus 4.3% with usual care (Hart et al., JAMA, 2026) [1].
Quitting was confirmed with lab tests, not just self-report (Hart et al., JAMA, 2026) [1].
Offering free medicines alone (5.1%) did not do significantly better than usual care in this trial (Hart et al., JAMA, 2026) [1].
Even with cash, about 91 in 100 participants did not achieve sustained abstinence, so quitting usually takes more than one tool.
Quitting helps at any age, even after decades of smoking (CDC) [7].
Who was in the cash incentives to quit smoking trial?
The study enrolled people who currently smoked and had been referred for lung cancer screening at four US health systems (five centers). Everyone in the trial identified as Black or Hispanic, lived in a rural area, or had low socioeconomic status, groups that often face more barriers to getting help with quitting (Hart et al., JAMA, 2026) [1].
Of 9,963 people screened, 3,259 were randomized and 3,220 were included in the main analysis. Their median age was 61. About 60% were women, about a quarter were Black, about 39% lived in rural areas, and about 75% had low socioeconomic status. More than half smoked over 10 cigarettes a day (Hart et al., JAMA, 2026) [1].
US Medicare rules already require health systems to offer stop-smoking services to people having lung cancer screening. The open question was which approach works best for people who are hardest to reach (Hart et al., JAMA, 2026) [1].
How did the study work?
Each person was randomly placed in one of four groups (Hart et al., JAMA, 2026) [1]:
Usual care: a clinician asked about smoking, advised quitting and referred the person to stop-smoking services.
Usual care plus free medicines: free nicotine replacement, plus reimbursement for the prescription drugs varenicline or bupropion.
Usual care plus free medicines plus cash: up to $600, paid only when lab tests confirmed the person was not smoking.
Everything in group 3, plus a text-message tool designed to get people thinking about their future health.
The cash was paid in steps: $100 at two weeks, $200 at three months and $300 at six months, each after a verified test (Penn Medicine, 2026). The main result was sustained abstinence through six months, checked with blood, urine or breath markers of tobacco use (cotinine, anabasine or carboxyhemoglobin) (Hart et al., JAMA, 2026) [1].
How much did cash help people quit?
Cash incentives to quit smoking about doubled quit rates, with about 9 in 100 people quitting with cash and free medicines compared with about 4 in 100 with usual care [1].
Study group | Verified quit rate at 6 months |
|---|---|
Usual care (ask, advise, refer) | 4.3% |
Usual care + free medicines | 5.1% |
Usual care + free medicines + up to $600 | 8.8% |
Same as above + text-message tool | 7.2% |
Source: Hart et al., JAMA, 2026 [1].
After adjusting for other factors, adding cash raised quit rates by 4.6 percentage points over usual care and by 4.1 points over free medicines alone. Both differences were statistically significant. Free medicines on their own were not significantly better than usual care (a difference of 0.5 points) (Hart et al., JAMA, 2026) [1].
Put simply: with usual care, about 4 in 100 people quit. With cash rewards and free medicines, about 9 in 100 did [1].
Why would cash incentives to quit smoking work?
Smoking gives instant rewards, while the health benefits of quitting arrive years later. A cash payment gives people something concrete and immediate to aim for during the hardest early weeks. The senior author noted that many participants had smoked for decades and likely tried to quit several times before (Penn Medicine, 2026).
This new trial fits a much larger body of evidence. Across 31 earlier trials, incentives raised long-term quit rates by about half (Notley et al., Cochrane Database of Systematic Reviews, 2019) [2].
Does this mean quit-smoking medicines don't work?
No. In this trial, simply offering free medicines did not clearly beat usual care. The study summary does not report how many people actually used the medicines, so that result tells us more about offering medicines than about taking them. Large reviews show that nicotine replacement, used as directed, raises the chance of quitting by 50% to 60% (Hartmann-Boyce et al., Cochrane Database of Systematic Reviews, 2018) [4]. In the cash group, people received the medicines too, so the 8.8% result reflects cash and medicines together [1].
What are the limits of this study?
Cash incentives to quit smoking were tested with clear limits, including only six months of follow-up, a specific group of people and most participants still not quitting.
Six months only. The main result covers six months. This trial alone cannot tell us how many people stayed smoke-free for years (Hart et al., JAMA, 2026) [1].
A specific group of people. Everyone had been referred for lung cancer screening and came from underserved groups, so results may differ in younger or other groups of people who smoke (Penn Medicine, 2026).
Most people still did not quit. Even in the best group, fewer than 1 in 10 achieved sustained, verified abstinence [1].
Not widely available. Researchers are still studying how to run incentive programs in real life and how the public feels about paying people to quit (Penn Medicine, 2026).
The text-message tool did not add benefit. Adding it to cash and medicines gave 7.2%, not higher than cash and medicines alone (Hart et al., JAMA, 2026) [1].
What can you do if you want to quit smoking now?
Quitting smoking does not require a cash program, since you can start now by talking with your provider about medicines and using simple ways to manage cravings. Practical steps include (Mayo Clinic Staff, 2025) [6]:
Talk with your healthcare provider about which nicotine replacement products or prescription medicines suit you [6].
Delay the urge. Set a timer for about 10 minutes and do something that holds your attention while the craving passes [6].
Keep your mouth busy with sugarless gum, crunchy vegetables, nuts or mints [6].
If you are eligible for lung cancer screening, ask whether your health system offers stop-smoking support alongside it. And if you have tried before, that is normal. Many people need several attempts.
Frequently asked questions
How much money did people get in the cash incentives to quit smoking trial?
Up to $600 in total: $100 at two weeks, $200 at three months and $300 at six months. Each payment required a lab test confirming the person was not smoking (Penn Medicine, 2026).
Do people go back to smoking once the payments stop?
Some do. This trial reported results through six months. However, a Cochrane review found that the benefit of incentives was still seen when studies that kept paying at the final check-up were excluded, suggesting the effect lasts for at least some time after payments end (Notley et al., Cochrane Database of Systematic Reviews, 2019).
Can I get paid to quit smoking?
Incentive programs are not widely available yet, and researchers are still working out how to offer them on a large scale (Penn Medicine, 2026). Ask your doctor, employer or health plan whether they offer any quit-smoking rewards or free support.
Is it worth quitting if I have smoked for decades?
Yes. Quitting has health benefits at any age, no matter how long or how much you have smoked, and it can add as much as 10 years to life expectancy (CDC).
Should I skip quit-smoking medicines and rely on willpower?
No. Nicotine replacement products raise the chance of quitting by 50% to 60% in large reviews (Hartmann-Boyce et al., Cochrane Database of Systematic Reviews, 2018). Talk with your healthcare provider about the best option for you.
Health information, not medical advice. This article explains published research for general education. It does not replace advice from your own doctor or pharmacist. Talk with a qualified healthcare professional before starting, stopping or changing any treatment.
Sources
Hart JL, et al. Smoking Cessation Among Underserved Patients Referred for Lung Cancer Screening: A Randomized Clinical Trial. JAMA. 2026. PMID 42832220. https://doi.org/10.1001/jama.2026.17192
Notley C, et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews. 2019;7(7):CD004307. PMID 31313293. https://doi.org/10.1002/14651858.CD004307.pub6
Halpern SD, et al. Randomized trial of four financial-incentive programs for smoking cessation. New England Journal of Medicine. 2015;372(22):2108-17. PMID 25970009. https://doi.org/10.1056/NEJMoa1414293
Hartmann-Boyce J, et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews. 2018;5(5):CD000146. PMID 29852054. https://doi.org/10.1002/14651858.CD000146.pub5
Penn Medicine. Cash rewards help underserved adults quit smoking. Penn Medicine News. October 5, 2026. https://www.pennmedicine.org/news/cash-rewards-help-underserved-adults-quit-smoking
Mayo Clinic Staff. Quitting smoking: 10 ways to resist tobacco cravings. Mayo Clinic. February 22, 2025. https://www.mayoclinic.org/healthy-lifestyle/quit-smoking/in-depth/nicotine-craving/art-20045454
Centers for Disease Control and Prevention. Benefits of Quitting Smoking. Centers for Disease Control and Prevention. Last reviewed May 15, 2024. https://www.cdc.gov/tobacco/about/benefits-of-quitting.html
About the author: Dr. Baraa Alnahhal, MD, is a medical doctor and the founder of Rinnit. Dr. Baraa Alnahhal reviews new medical research and translates it into clear, evidence-based health information for everyday readers.
Comments