Can Financial Incentives of Up to $600 Help Smokers Quit?

By
Debbie Bunch
October 20, 2026

American Association For Respiratory Care

Overview

In a randomized clinical trial of more than 3,200 current smokers referred for low-dose CT lung cancer screening, six-month abstinence was highest in the group offered usual care, free cessation medications, and financial incentives. Biochemically verified quit rates were 8% with incentives and medications, compared with 3% with usual care alone; adding the FutureMe text-based tool to incentives and medications was associated with a 2% quit rate.

Background

Smoking cessation is a focus of clinical and public-health interventions, including behavioral support and pharmacotherapy. The reported trial studied people referred for lung cancer screening, including participants who were Black or Hispanic, had limited incomes, or lived in rural communities. The USPSTF recommends behavioral interventions and FDA-approved pharmacotherapy for nonpregnant adults who use tobacco, while WHO guidance addresses evidence-based behavioral and pharmacologic treatment for adults. NICE guidance specifically recommends voucher incentives to support smoking cessation during pregnancy.

Data Highlights

Trial group	Six-month abstinence
Usual care alone	3%
Usual care plus free cessation medications	1%
Usual care, free medications, and financial incentives	8%
Usual care, free medications, incentives, and FutureMe	2%

More than 3,200 current smokers were enrolled. Abstinence was verified by blood testing after six months of follow-up.

Key Findings

The trial enrolled more than 3,200 current smokers referred to low-dose CT lung cancer screening at multiple U.S. medical centers.
Participants were assigned to four approaches: usual ask-advise-refer care; usual care plus free cessation medications; usual care plus medications and financial incentives; or the latter combination plus FutureMe, a text-based behavioral tool.
Reported six-month quit rates were 3% with usual care alone and 1% with usual care plus free medications.
The group receiving usual care, free medications, and financial incentives had an 8% quit rate.
The group receiving usual care, free medications, incentives, and FutureMe had a 2% quit rate.
Scott D. Halpern, MD, PhD, said incentives improved cessation rates among participants who may be difficult to engage through conventional methods; investigators plan additional trials on broader implementation.

Clinical Implications

The trial authors reported higher cessation rates in the arm combining financial incentives with free medications than in the usual-care or medication-only arms, while the arm that also included FutureMe had a lower reported rate. The USPSTF recommends behavioral interventions and FDA-approved pharmacotherapy for nonpregnant adults who use tobacco; the trial findings concern a specific lung-screening-referred population and do not establish results beyond the reported study.

Conclusion

In this lung-screening-referred cohort, the highest reported six-month abstinence rate occurred with usual care, free cessation medications, and financial incentives. Further trials are planned to examine how incentive-based programs can be implemented more broadly.