A CO-Verified Financial Incentive Pilot for Smoking Reduction in a University Workplace in Mainland China

Abstract

AbstractBackground: Smoking remains a major cause of preventable morbidity and mortality, and cessation success remains limited in many real-world settings. Financial incentives may improve smoking related outcomes by providing immediate reinforcement during the early withdrawal-sensitive phase of quitting, but evidence from mainland China workplace settings remains limited. This pilot study examined short-term smoking- related outcomes, feasibility, and selected exploratory psychosocial outcomes of an exhaled carbon monoxide-verified financial incentive program implemented in a university workplace in mainland China. Methods: We conducted a workplace-based pilot single-arm pre-post pilot study among university employees in frontline support roles, predominantly security staff, who smoked at least one cigarette per day and were able to attend daily testing (N=30). Recruitment began in June 2025. Participants completed a baseline questionnaire, followed by a 7-day CO-verified financial incentive intervention (daily exhaled CO testing using a Smokerlyzer® device). Participants with CO ≤10 ppm received an immediate 50 RMB reward via WeChat transfer; those attending all 7 days with no CO >10 ppm received an additional 100 RMB bonus. A post-intervention v questionnaire was completed at day 7. One week after the intervention, participants were invited for an unannounced follow-up CO assessment and brief follow-up questionnaire. Primary outcomes were short-term smoking-related changes (self- reported smoking quantity, smoking-related intention/likelihood, and CO levels). Secondary outcomes were feasibility indicators (recruitment, attendance, retention, daily testing completion, and incentive delivery). Exploratory psychosocial outcomes included life satisfaction. Results: The final intervention analysis sample included 30 participants; all were male, the mean age was 31.7 years (SD = 12.3), and all completed the 7-day intervention. Twenty-nine of 30 participants (96.7%) completed the unannounced follow-up CO assessment. Participants met the CO qualification threshold (≤10 ppm) on a mean of 6.87 days (SD = 0.51), and 28/30 (93.3%) were eligible for the 7-day bonus, indicating strong adherence. Mean CO decreased from 4.90 ppm (SD = 4.44) on day 1 to 3.50 ppm (SD = 1.66) on day 7, with lower and more tightly clustered values by day 7. At follow-up, mean CO increased to 5.28 ppm (SD = 3.82; n = 29), suggesting partial rebound after incentives ended. Self-reported smoking quantity shifted significantly toward lower categories after the intervention (Stuart–Maxwell test for marginal homogeneity, p = 0.0028), and time since last cigarette shifted toward longer intervals among the 28 participants with complete paired data (p = 0.0213). The vi perceived likelihood of continuing smoking without incentives decreased from 3.00 (SD = 0.91) to 2.33 (SD = 0.92) (p = 0.001), and life satisfaction increased from 4.23 (SD = 1.36) to 5.27 (SD = 1.41) (p < 0.001), although these psychosocial findings should be interpreted as exploratory. Conclusions: A short-term, CO-verified financial incentive program appeared feasible under the conditions of this pilot and was associated with favorable short-term smoking-related changes during the active intervention period. However, follow-up findings suggested partial rebound after incentives ended, and CO findings should be interpreted cautiously because the interval since the last cigarette was not systematically recorded. Larger controlled studies with longer follow-up are needed to evaluate effectiveness, cost-benefit, and scalability.