Contingencies for Change in Complacent Smokers

The majority of smokers have no plans to quit in the near future. These complacent smokers are less likely to quit than other smokers, and few interventions are known to reduce smoking in this population. Although monetary incentives can reduce complacent smokers' breath carbon monoxide (BCO) levels, it is not clear whether these effects can be sustained beyond the several weeks that past studies have examined. The authors compared complacent smokers randomly assigned to receive incentives for BCO reductions (n = 18) or noncontingent incentives (n = 19) for 3 months. Contingent incentives were associated with (a) reduced BCO; (b) more BCO samples indicative of abstinence; (c) fewer cigarettes smoked and more days abstinent at study end; and (d) lower salivary cotinine. These behaviors can predict future cessation, and 2 of the 18 smokers (11%) receiving BCO-contingent incentives reported quitting as compared with none in the control group. Contingency management procedures, such as those used here, may effectively promote cessation among complacent smokers and provide a model for understanding the possible effects of some environmental interventions (like workplace smoking bans) on the behavior of complacent smokers.