A Team-Based Behavioral Economics Approach to Health Behavior Change: Results from a Smoking Cessation Trial in Thailand

Behavioral economics is an innovative new field, yet its practical applications to health in developing countries have not been fully explored. This study evaluates the effectiveness of a team-based intervention for smoking cessation in rural communities of Thailand. Tobacco use is a leading cause of death and disease in rural areas, yet smoking cessation programs are not widely available in most developing countries. Novel, community-based approaches to smoking treatment are needed in remote areas where conventional treatments are not feasible. This study assesses if a smoker quits successfully after depositing money with a community health worker that is returned only if he quits and receiving a cash bonus if the smoker and an assigned teammate both quit successfully. According to behavioral economics theory, voluntary but binding financial commitments help people to overcome self-control problems. The team bonus is designed to promote cooperation and activate peer pressure to foster positive health behavior. Our study randomly assigned 215 smokers from 30 villages in central Thailand — about 10% of all smokers in the villages — to receive the team commitment contract or counseling only. Six months after enrollment (three months after the incentives ended), 44% of the treatment arm had quit, compared to 19% of the control arm. The intervention provides evidence on the strong effects of a novel blend of social and financial incentives, highly favorable relative to other behavioral and clinical interventions. Further, it highlights the potential of new, low-cost behavioral economics approaches to promote behavior change in developing countries.