奖励还是惩罚 更有利于戒烟

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.

想让吸烟者戒烟，是对戒烟成功大加奖励还是对戒烟失败小施惩戒更加有效？为了搞清楚这个问题，研究人员让CVS药店(CVS)的一大群员工及其亲朋好友接受了不同的戒烟方案。

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.

他们得到的答案展示了人类行为中令人惊讶的一面。有很多人都愿意参加奖励方案，但在加入之后，真正戒了烟的人寥寥无几。而在同意冒险尝试惩罚方案的那一小部分人当中，成功戒烟的可能性却是前者的两倍。

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.

这项试验于5月13日发表在《新英格兰医学杂志》(The New England Journal of Medicine)上，它是迄今为止规模最大的一项以测试经济奖励能否改善人们健康为目的的研究。该试验采用了心理学和经济学部门在近几十年来建立起来的人类决策理论，并将其应用于美国最大的连锁药店CVS Caremark公司的员工及其朋友或亲戚。合计参与人数超过了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.

研究人员发现，与传统的戒烟方法，即通过各种方式免费帮人戒烟（如提供咨询，使用口香糖、药物或贴片等尼古丁替代疗法）相比，提供奖励的效果要好得多。但他们也发现，如果要求参与者交150美元保证金，且告知他们在6个月内无法戒烟就拿不回保证金，戒烟的成功率几乎可以翻一番。

“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.

该研究的负责人，宾夕法尼亚大学医学院(University of Pennsylvania School of Medicine)健康激励和行为经济学研究中心(Center for Health Incentives and Behavioral Economics)副主任斯科特·哈尔彭(Scott Halpern)博士说：“胡萝卜加一点大棒的效果比纯用胡萝卜更好。”

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.

在这个医疗费用不断上涨的时代，上述发现很可能会引起那些正在考虑该为自己的员工提供何种福利待遇的大公司的关注。大多数大型用人单位承担着员工医疗费用的绝大部分，他们现在多以员工保健计划(employee wellness programs)的形式来激励促进健康的行为，但到目前为止，还没有多少证据能证实哪种方案可以真正有效地指导他们。

CVS, which helped conduct the study, is using the findings to design a smoking cessation incentive next month for its more than 200,000 employees.

CVS（也就是协助进行该研究的公司）下个月将利用上述研究成果为其20多万名员工设计激励戒烟的方案。

“These large employers are spending an average of $800 to $900 per employee per year, but in ways that are often blind to normal human psychology,” Dr. Halpern said, adding that the spending on wellness had nearly doubled in five years.

“这些大型用人单位每年平均要在每名员工身上花费800到900美元，”哈尔彭博士说，5年内医疗支出增加了近一倍，“但他们花钱时却往往对人员心理层面上的因素视而不见。”

The trial was intended to change that. Researchers randomly assigned the participants to a number of program options and let them decide whether they wanted to participate. About 14 percent of people assigned to the penalty program accepted it, compared with about 90 percent of people assigned to the reward program.

这项试验就是为了要改变这一现状。研究人员向参与者们随机分配了多种戒烟方案，并让他们自己决定是否参加。分配入惩罚方案组的参与者中约有14%表示接受，相比之下，分配入奖励方案组的参与者中接受者高达90%。

The penalty program required participants to deposit $150; six months later, those who had quit smoking would get the deposit back, along with a $650 reward. In the reward-only program, participants were simply offered an $800 payment if they stayed off cigarettes for six months.

惩罚方案要求参与者缴纳150美元保证金；6个月后，成功戒烟者不但得以退还保证金，还将获得650美元的奖励。而在纯奖励方案中，参加者戒烟6个月就可以获得800美元的奖励。

The success rate for those who joined the pure rewards group was low, about 17 percent, compared with more than 50 percent for the penalty program, though the figures had to be adjusted to account for the possibility that those who opted for the penalty might have been more motivated to quit to begin with.

纯奖励方案组的参与者中戒烟成功率很低，约为17%；相比之下，在惩罚方案组中成功率则超过了50%。不过，考虑到愿意接受惩罚方案的参与者有可能从一开始就有较高的戒烟积极性，仍需对上述数字加以校正。

Even after that adjustment, those who signed up for the penalty were nearly twice as likely to quit as those who opted for pure rewards, and five times as likely to quit as those who just got free counseling or nicotine replacement therapy. Even so, the largest overall effect was among the group that was assigned to pure rewards, simply because so many more people took part.

但即使经过这么一番校正，愿意接受惩罚方案的参与者戒烟的可能性仍是选择单纯奖励方案者的近两倍，是只接受免费咨询或尼古丁替代疗法者的五倍。纵然如此，整体效果最好的仍要数纯奖励组，因为这组的参与者人数要多得多。

“This is an original set of findings,” said Cass R. Sunstein, a Harvard law professor who helped develop some influential ideas in the field of behavioral economics, notably that if the social environment can be changed — for example, by posting simple warnings — people can be nudged into better behavior. “They could be applied to many health issues, like alcoholism, or whenever people face serious self-control problems.”

哈佛大学法学院的教授卡斯·R·桑斯坦( Cass R. Sunstein)说：“这些发现很有独创性，可以应用于酗酒等很多健康问题，或是人面临严重自我控制问题的时候。”桑斯坦教授曾帮助建立起行为经济学领域的某些深具影响力的观点，其中特别值得一提的是：改变社会环境（例如，张贴简单的警告）可以敦促人们改善自己的行为。

Professor Sunstein, who oversaw regulatory policy for the Obama administration from 2009 to 2012 and now directs the Program on Behavioral Economics and Public Policy at Harvard, wrote an opinion article on the study, but was not involved in it.

2009年至2012年期间，他负责了奥巴马政府的管控政策，现在是哈佛大学行为经济学和公共政策项目(Program on Behavioral Economics and Public Policy)负责人。他为上文介绍的研究撰写过评论文章，但并没有实际参与其中。

Over all, success eluded most of the study participants. More than 80 percent of smokers in the most popular pure rewards group were still smoking at the end of the study. Even so, researchers say, their success rate was far greater than for those who got the traditional treatment, signaling that there could be substantial public health benefits in offering financial incentives.

总体而言，大多数研究参与者都没能成功戒烟。在研究结束时，最受欢迎的纯奖励组中有超过80%的吸烟者依旧在吸烟。但研究人员表示，即便如此，他们的成功率仍远远超过了传统疗法，这表明提供经济奖励有可能带来重大的公共卫生效益。

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.

在美国，吸烟是可预防性死亡的首要原因。每年因吸烟相关疾病致死的美国人超过48万人。因此，哪怕是吸烟率的小小降低也将带来巨大的健康效应。