戒菸最有效的方法是獎勵還是懲罰?

What would make a smoker more likely to quit, a big reward for succeeding or a little penalty for failing? That is what researchers wanted to know when they assigned a large group of CVS employees, their relatives and friends to different smoking cessation programs.

想讓吸菸者戒菸，是對戒菸成功大加獎勵還是對戒菸失敗小施懲戒更加有效？爲了搞清楚這個問題，研究人員讓CVS藥店的一大羣員工及其親朋好友接受了不同的戒菸方案。

The answer offered a surprising insight into human behavior. Many more people agreed to sign up for the reward program, but once they were in it, only a small share actually quit smoking. A far smaller number agreed to risk the penalty, but those who did were twice as likely to quit.

他們得到的答案展示了人類行爲中令人驚訝的一面。有很多人都願意參加獎勵方案，但在加入之後，真正戒了煙的人寥寥無幾。而在同意冒險嘗試懲罰方案的那一小部分人當中，成功戒菸的可能性卻是前者的兩倍。

The trial, which was described in The New England Journal of Medicine on Wednesday, was the largest yet to test whether offering people financial incentives could lead to better health. It used theories about human decision making that have been developed in psychology and economics departments over several decades and put them into practice with more than 2,500 people who either worked at CVS Caremark, the country's largest drugstore chain by sales, or were friends or relatives of those employees.

這項試驗於5月13日發表在《新英格蘭醫學雜誌》上，它是迄今爲止規模最大的一項以測試經濟獎勵能否改善人們健康爲目的的研究。該試驗採用了心理學和經濟學部門在近幾十年來建立起來的人類決策理論，並將其應用於美國最大的連鎖藥店CVS Caremark公司的員工及其朋友或親戚。合計參與人數超過了2500人。

Researchers found that offering incentives was far more effective in getting people to stop smoking than the traditional approach of giving free smoking cessation help, such as counseling or nicotine replacement therapy like gum, medication or patches. But they also found that requiring a $150 deposit that would be lost if the person failed to stay off cigarettes for six months nearly doubled the chances of success.

研究人員發現，與傳統的戒菸方法，即通過各種方式免費幫人戒菸（如提供諮詢，使用口香糖、藥物或貼片等尼古丁替代療法）相比，提供獎勵的效果要好得多。但他們也發現，如果要求參與者交150美元保證金，且告知他們在6個月內無法戒菸就拿不回保證金，戒菸的成功率幾乎可以翻一番。

“Adding a bit of a stick was much better than a pure carrot,” said Dr. Scott Halpern, deputy director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania School of Medicine, who led the study.

該研究的負責人，賓夕法尼亞大學醫學院健康激勵和行爲經濟學研究中心副主任斯科特·哈爾彭博士說：“胡蘿蔔加一點大棒的效果比純用胡蘿蔔更好。”

The finding is likely to get the attention of large companies as they sort out what types of benefits to offer employees in an era of rising health care costs. Most large employers, which bear much of those costs, now offer incentives for health-promoting behavior in the form of employee wellness programs, but until now, they have had little evidence of what types of programs actually work to guide them.

在這個醫療費用不斷上漲的時代，上述發現很可能會引起那些正在考慮該爲自己的員工提供何種福利待遇的大公司的關注。大多數大型用人單位承擔着員工醫療費用的絕大部分，他們現在多以員工保健計劃的形式來激勵促進健康的行爲，但到目前爲止，還沒有多少證據能證實哪種方案可以真正有效地指導他們。

And even a small decline could have a big health effect. Smoking is the largest cause of preventable death in the United States. Diseases linked to it kill more than 480,000 Americans a year.

在美國，吸菸是可預防性死亡的首要原因。每年因吸菸相關疾病致死的美國人超過48萬人。因此，哪怕是吸菸率的小小降低也將帶來巨大的健康效應。