獎(jiǎng)勵(lì)還是懲罰 更有利于戒煙
What would make a smoker more likely to quit, a bigreward for succeeding or a little penalty for failing? That is what researchers wanted to knowwhen they assigned a large group of CVS employees, their relatives and friends to differentsmoking cessation programs.
想讓吸煙者戒煙，是對(duì)戒煙成功大加獎(jiǎng)勵(lì)還是對(duì)戒煙失敗小施懲戒更加有效?為了搞清楚這個(gè)問(wèn)題，研究人員讓CVS藥店(CVS)的一大群?jiǎn)T工及其親朋好友接受了不同的戒煙方案。
The answer offered a surprising insight into human behavior. Many more people agreed to signup for the reward program, but once they were in it, only a small share actually quit smoking. Afar 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為中令人驚訝的一面。有很多人都愿意參加獎(jiǎng)勵(lì)方案，但在加入之后，真正戒了煙的人寥寥無(wú)幾。而在同意冒險(xiǎn)嘗試懲罰方案的那一小部分人當(dāng)中，成功戒煙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 thelargest yet to test whether offering people financial incentives could lead to better health. Itused theories about human decision making that have been developed in psychology andeconomics departments over several decades and put them into practice with more than 2,500people who either worked at CVS Caremark, the country’s largest drugstore chain by sales, orwere friends or relatives of those employees.
這項(xiàng)試驗(yàn)于5月13日發(fā)表在《新英格蘭醫(yī)學(xué)雜志》(The New England Journal of Medicine)上，它是迄今為止規(guī)模最大的一項(xiàng)以測(cè)試經(jīng)濟(jì)獎(jiǎng)勵(lì)能否改善人們健康為目的的研究。該試驗(yàn)采用了心理學(xué)和經(jīng)濟(jì)學(xué)部門在近幾十年來(lái)建立起來(lái)的人類決策理論，并將其應(yīng)用于美國(guó)最大的連鎖藥店CVS Caremark公司的員工及其朋友或親戚。合計(jì)參與人數(shù)超過(guò)了2500人。
Researchers found that offering incentives was far more effective in getting people to stopsmoking than the traditional approach of giving free smoking cessation help, such ascounseling or nicotine replacement therapy like gum, medication or patches. But they alsofound that requiring a $150 deposit that would be lost if the person failed to stay off cigarettesfor six months nearly doubled the chances of success.
研究人員發(fā)現(xiàn)，與傳統(tǒng)的戒煙方法，即通過(guò)各種方式免費(fèi)幫人戒煙(如提供咨詢，使用口香糖、藥物或貼片等尼古丁替代療法)相比，提供獎(jiǎng)勵(lì)的效果要好得多。但他們也發(fā)現(xiàn)，如果要求參與者交150美元保證金，且告知他們?cè)?個(gè)月內(nèi)無(wú)法戒煙就拿不回保證金，戒煙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, deputydirector of the Center for Health Incentives and Behavioral Economics at the University ofPennsylvania School of Medicine, who led the study.
該研究的負(fù)責(zé)人，賓夕法尼亞大學(xué)醫(yī)學(xué)院(University of Pennsylvania School of Medicine)健康激勵(lì)和行為經(jīng)濟(jì)學(xué)研究中心(Center for Health Incentives and Behavioral Economics)副主任斯科特·哈爾彭(ScottHalpern)博士說(shuō)：“胡蘿卜加一點(diǎn)大棒的效果比純用胡蘿卜更好。
The finding is likely to get the attention of large companies as they sort out what types ofbenefits to offer employees in an era of rising health care costs. Most large employers, whichbear much of those costs, now offer incentives for health-promoting behavior in the form ofemployee wellness programs, but until now, they have had little evidence of what types ofprograms actually work to guide them.
在這個(gè)醫(yī)療費(fèi)用不斷上漲的時(shí)代，上述發(fā)現(xiàn)很可能會(huì)引起那些正在考慮該為自己的員工提供何種福利待遇的大公司的關(guān)注。大多數(shù)大型用人單位承擔(dān)著員工醫(yī)療費(fèi)用的絕大部分，他們現(xiàn)在多以員工保健計(jì)劃(employeewellness programs)的形式來(lái)激勵(lì)促進(jìn)健康的行為，但到目前為止，還沒(méi)有多少證據(jù)能證實(shí)哪種方案可以真正有效地指導(dǎo)他們。
CVS, which helped conduct the study, is using the findings to design a smoking cessationincentive next month for its more than 200,000 employees.
CVS(也就是協(xié)助進(jìn)行該研究的公司)下個(gè)月將利用上述研究成果為其20多萬(wàn)名員工設(shè)計(jì)激勵(lì)戒煙的方案。
“These large employers are spending an average of $800 to $900 per employee per year, butin ways that are often blind to normal human psychology, Dr. Halpern said, adding that thespending on wellness had nearly doubled in five years.
“這些大型用人單位每年平均要在每名員工身上花費(fèi)800到900美元，哈爾彭博士說(shuō)，5年內(nèi)醫(yī)療支出增加了近一倍，“但他們花錢時(shí)卻往往對(duì)人員心理層面上的因素視而不見(jiàn)。
The trial was intended to change that. Researchers randomly assigned the participants to anumber of program options and let them decide whether they wanted to participate. About 14percent of people assigned to the penalty program accepted it, compared with about 90percent of people assigned to the reward program.
這項(xiàng)試驗(yàn)就是為了要改變這一現(xiàn)狀。研究人員向參與者們隨機(jī)分配了多種戒煙方案，并讓他們自己決定是否參加。分配入懲罰方案組的參與者中約有14%表示接受，相比之下，分配入獎(jiǎng)勵(lì)方案組的參與者中接受者高達(dá)90%。
The penalty program required participants to deposit $150; six months later, those who hadquit smoking would get the deposit back, along with a $650 reward. In the reward-onlyprogram, participants were simply offered an $800 payment if they stayed off cigarettes for sixmonths.
懲罰方案要求參與者繳納150美元保證金;6個(gè)月后，成功戒煙者不但得以退還保證金，還將獲得650美元的獎(jiǎng)勵(lì)。而在純獎(jiǎng)勵(lì)方案中，參加者戒煙6個(gè)月就可以獲得800美元的獎(jiǎng)勵(lì)。
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 beadjusted to account for the possibility that those who opted for the penalty might have beenmore motivated to quit to begin with.
純獎(jiǎng)勵(lì)方案組的參與者中戒煙成功率很低，約為17%;相比之下，在懲罰方案組中成功率則超過(guò)了50%。不過(guò)，考慮到愿意接受懲罰方案的參與者有可能從一開(kāi)始就有較高的戒煙積極性，仍需對(duì)上述數(shù)字加以校正。
Even after that adjustment, those who signed up for the penalty were nearly twice as likely toquit as those who opted for pure rewards, and five times as likely to quit as those who just gotfree counseling or nicotine replacement therapy. Even so, the largest overall effect wasamong the group that was assigned to pure rewards, simply because so many more peopletook part.
但即使經(jīng)過(guò)這么一番校正，愿意接受懲罰方案的參與者戒煙的可能性仍是選擇單純獎(jiǎng)勵(lì)方案者的近兩倍，是只接受免費(fèi)咨詢或尼古丁替代療法者的五倍?？v然如此，整體效果最好的仍要數(shù)純獎(jiǎng)勵(lì)組，因?yàn)檫@組的參與者人數(shù)要多得多。
“This is an original set of findings, said Cass R. Sunstein, a Harvard law professor who helpeddevelop some influential ideas in the field of behavioral economics, notably that if the socialenvironment can be changed — for example, by posting simple warnings — people can benudged into better behavior. “They could be applied to many health issues, like alcoholism, orwhenever people face serious self-control problems.
哈佛大學(xué)法學(xué)院的教授卡斯·R·桑斯坦( Cass R. Sunstein)說(shuō)：“這些發(fā)現(xiàn)很有獨(dú)創(chuàng)性，可以應(yīng)用于酗酒等很多健康問(wèn)題，或是人面臨嚴(yán)重自我控制問(wèn)題的時(shí)候。桑斯坦教授曾幫助建立起行為經(jīng)濟(jì)學(xué)領(lǐng)域的某些深具影響力的觀點(diǎn)，其中特別值得一提的是：改變社會(huì)環(huán)境(例如，張貼簡(jiǎn)單的警告)可以敦促人們改善自己的行為。
Professor Sunstein, who oversaw regulatory policy for the Obama administration from 2009 to2023 and now directs the Program on Behavioral Economics and Public Policy at Harvard, wrotean opinion article on the study, but was not involved in it.
2009年至2023年期間，他負(fù)責(zé)了奧巴馬政府的管控政策，現(xiàn)在是哈佛大學(xué)行為經(jīng)濟(jì)學(xué)和公共政策項(xiàng)目(Program on Behavioral Economics and Public Policy)負(fù)責(zé)人。他為上文介紹的研究撰寫過(guò)評(píng)論文章，但并沒(méi)有實(shí)際參與其中。
Over all, success eluded most of the study participants. More than 80 percent of smokers in themost 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 traditionaltreatment, signaling that there could be substantial public health benefits in offering financialincentives.
總體而言，大多數(shù)研究參與者都沒(méi)能成功戒煙。在研究結(jié)束時(shí)，最受歡迎的純獎(jiǎng)勵(lì)組中有超過(guò)80%的吸煙者依舊在吸煙。但研究人員表示，即便如此，他們的成功率仍遠(yuǎn)遠(yuǎn)超過(guò)了傳統(tǒng)療法，這表明提供經(jīng)濟(jì)獎(jiǎng)勵(lì)有可能帶來(lái)重大的公共衛(wèi)生效益。
And even a small decline could have a big health effect. Smoking is the largest cause ofpreventable death in the United States. Diseases linked to it kill more than 480,000 Americansa year.
在美國(guó)，吸煙是可預(yù)防性死亡的首要原因。每年因吸煙相關(guān)疾病致死的美國(guó)人超過(guò)48萬(wàn)人。因此，哪怕是吸煙率的小小降低也將帶來(lái)巨大的健康效應(yīng)。
What would make a smoker more likely to quit, a bigreward for succeeding or a little penalty for failing? That is what researchers wanted to knowwhen they assigned a large group of CVS employees, their relatives and friends to differentsmoking cessation programs.
想讓吸煙者戒煙，是對(duì)戒煙成功大加獎(jiǎng)勵(lì)還是對(duì)戒煙失敗小施懲戒更加有效?為了搞清楚這個(gè)問(wèn)題，研究人員讓CVS藥店(CVS)的一大群?jiǎn)T工及其親朋好友接受了不同的戒煙方案。
The answer offered a surprising insight into human behavior. Many more people agreed to signup for the reward program, but once they were in it, only a small share actually quit smoking. Afar 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為中令人驚訝的一面。有很多人都愿意參加獎(jiǎng)勵(lì)方案，但在加入之后，真正戒了煙的人寥寥無(wú)幾。而在同意冒險(xiǎn)嘗試懲罰方案的那一小部分人當(dāng)中，成功戒煙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 thelargest yet to test whether offering people financial incentives could lead to better health. Itused theories about human decision making that have been developed in psychology andeconomics departments over several decades and put them into practice with more than 2,500people who either worked at CVS Caremark, the country’s largest drugstore chain by sales, orwere friends or relatives of those employees.
這項(xiàng)試驗(yàn)于5月13日發(fā)表在《新英格蘭醫(yī)學(xué)雜志》(The New England Journal of Medicine)上，它是迄今為止規(guī)模最大的一項(xiàng)以測(cè)試經(jīng)濟(jì)獎(jiǎng)勵(lì)能否改善人們健康為目的的研究。該試驗(yàn)采用了心理學(xué)和經(jīng)濟(jì)學(xué)部門在近幾十年來(lái)建立起來(lái)的人類決策理論，并將其應(yīng)用于美國(guó)最大的連鎖藥店CVS Caremark公司的員工及其朋友或親戚。合計(jì)參與人數(shù)超過(guò)了2500人。
Researchers found that offering incentives was far more effective in getting people to stopsmoking than the traditional approach of giving free smoking cessation help, such ascounseling or nicotine replacement therapy like gum, medication or patches. But they alsofound that requiring a $150 deposit that would be lost if the person failed to stay off cigarettesfor six months nearly doubled the chances of success.
研究人員發(fā)現(xiàn)，與傳統(tǒng)的戒煙方法，即通過(guò)各種方式免費(fèi)幫人戒煙(如提供咨詢，使用口香糖、藥物或貼片等尼古丁替代療法)相比，提供獎(jiǎng)勵(lì)的效果要好得多。但他們也發(fā)現(xiàn)，如果要求參與者交150美元保證金，且告知他們?cè)?個(gè)月內(nèi)無(wú)法戒煙就拿不回保證金，戒煙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, deputydirector of the Center for Health Incentives and Behavioral Economics at the University ofPennsylvania School of Medicine, who led the study.
該研究的負(fù)責(zé)人，賓夕法尼亞大學(xué)醫(yī)學(xué)院(University of Pennsylvania School of Medicine)健康激勵(lì)和行為經(jīng)濟(jì)學(xué)研究中心(Center for Health Incentives and Behavioral Economics)副主任斯科特·哈爾彭(ScottHalpern)博士說(shuō)：“胡蘿卜加一點(diǎn)大棒的效果比純用胡蘿卜更好。
The finding is likely to get the attention of large companies as they sort out what types ofbenefits to offer employees in an era of rising health care costs. Most large employers, whichbear much of those costs, now offer incentives for health-promoting behavior in the form ofemployee wellness programs, but until now, they have had little evidence of what types ofprograms actually work to guide them.
在這個(gè)醫(yī)療費(fèi)用不斷上漲的時(shí)代，上述發(fā)現(xiàn)很可能會(huì)引起那些正在考慮該為自己的員工提供何種福利待遇的大公司的關(guān)注。大多數(shù)大型用人單位承擔(dān)著員工醫(yī)療費(fèi)用的絕大部分，他們現(xiàn)在多以員工保健計(jì)劃(employeewellness programs)的形式來(lái)激勵(lì)促進(jìn)健康的行為，但到目前為止，還沒(méi)有多少證據(jù)能證實(shí)哪種方案可以真正有效地指導(dǎo)他們。
CVS, which helped conduct the study, is using the findings to design a smoking cessationincentive next month for its more than 200,000 employees.
CVS(也就是協(xié)助進(jìn)行該研究的公司)下個(gè)月將利用上述研究成果為其20多萬(wàn)名員工設(shè)計(jì)激勵(lì)戒煙的方案。
“These large employers are spending an average of $800 to $900 per employee per year, butin ways that are often blind to normal human psychology, Dr. Halpern said, adding that thespending on wellness had nearly doubled in five years.
“這些大型用人單位每年平均要在每名員工身上花費(fèi)800到900美元，哈爾彭博士說(shuō)，5年內(nèi)醫(yī)療支出增加了近一倍，“但他們花錢時(shí)卻往往對(duì)人員心理層面上的因素視而不見(jiàn)。
The trial was intended to change that. Researchers randomly assigned the participants to anumber of program options and let them decide whether they wanted to participate. About 14percent of people assigned to the penalty program accepted it, compared with about 90percent of people assigned to the reward program.
這項(xiàng)試驗(yàn)就是為了要改變這一現(xiàn)狀。研究人員向參與者們隨機(jī)分配了多種戒煙方案，并讓他們自己決定是否參加。分配入懲罰方案組的參與者中約有14%表示接受，相比之下，分配入獎(jiǎng)勵(lì)方案組的參與者中接受者高達(dá)90%。
The penalty program required participants to deposit $150; six months later, those who hadquit smoking would get the deposit back, along with a $650 reward. In the reward-onlyprogram, participants were simply offered an $800 payment if they stayed off cigarettes for sixmonths.
懲罰方案要求參與者繳納150美元保證金;6個(gè)月后，成功戒煙者不但得以退還保證金，還將獲得650美元的獎(jiǎng)勵(lì)。而在純獎(jiǎng)勵(lì)方案中，參加者戒煙6個(gè)月就可以獲得800美元的獎(jiǎng)勵(lì)。
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 beadjusted to account for the possibility that those who opted for the penalty might have beenmore motivated to quit to begin with.
純獎(jiǎng)勵(lì)方案組的參與者中戒煙成功率很低，約為17%;相比之下，在懲罰方案組中成功率則超過(guò)了50%。不過(guò)，考慮到愿意接受懲罰方案的參與者有可能從一開(kāi)始就有較高的戒煙積極性，仍需對(duì)上述數(shù)字加以校正。
Even after that adjustment, those who signed up for the penalty were nearly twice as likely toquit as those who opted for pure rewards, and five times as likely to quit as those who just gotfree counseling or nicotine replacement therapy. Even so, the largest overall effect wasamong the group that was assigned to pure rewards, simply because so many more peopletook part.
但即使經(jīng)過(guò)這么一番校正，愿意接受懲罰方案的參與者戒煙的可能性仍是選擇單純獎(jiǎng)勵(lì)方案者的近兩倍，是只接受免費(fèi)咨詢或尼古丁替代療法者的五倍?？v然如此，整體效果最好的仍要數(shù)純獎(jiǎng)勵(lì)組，因?yàn)檫@組的參與者人數(shù)要多得多。
“This is an original set of findings, said Cass R. Sunstein, a Harvard law professor who helpeddevelop some influential ideas in the field of behavioral economics, notably that if the socialenvironment can be changed — for example, by posting simple warnings — people can benudged into better behavior. “They could be applied to many health issues, like alcoholism, orwhenever people face serious self-control problems.
哈佛大學(xué)法學(xué)院的教授卡斯·R·桑斯坦( Cass R. Sunstein)說(shuō)：“這些發(fā)現(xiàn)很有獨(dú)創(chuàng)性，可以應(yīng)用于酗酒等很多健康問(wèn)題，或是人面臨嚴(yán)重自我控制問(wèn)題的時(shí)候。桑斯坦教授曾幫助建立起行為經(jīng)濟(jì)學(xué)領(lǐng)域的某些深具影響力的觀點(diǎn)，其中特別值得一提的是：改變社會(huì)環(huán)境(例如，張貼簡(jiǎn)單的警告)可以敦促人們改善自己的行為。
Professor Sunstein, who oversaw regulatory policy for the Obama administration from 2009 to2023 and now directs the Program on Behavioral Economics and Public Policy at Harvard, wrotean opinion article on the study, but was not involved in it.
2009年至2023年期間，他負(fù)責(zé)了奧巴馬政府的管控政策，現(xiàn)在是哈佛大學(xué)行為經(jīng)濟(jì)學(xué)和公共政策項(xiàng)目(Program on Behavioral Economics and Public Policy)負(fù)責(zé)人。他為上文介紹的研究撰寫過(guò)評(píng)論文章，但并沒(méi)有實(shí)際參與其中。
Over all, success eluded most of the study participants. More than 80 percent of smokers in themost 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 traditionaltreatment, signaling that there could be substantial public health benefits in offering financialincentives.
總體而言，大多數(shù)研究參與者都沒(méi)能成功戒煙。在研究結(jié)束時(shí)，最受歡迎的純獎(jiǎng)勵(lì)組中有超過(guò)80%的吸煙者依舊在吸煙。但研究人員表示，即便如此，他們的成功率仍遠(yuǎn)遠(yuǎn)超過(guò)了傳統(tǒng)療法，這表明提供經(jīng)濟(jì)獎(jiǎng)勵(lì)有可能帶來(lái)重大的公共衛(wèi)生效益。
And even a small decline could have a big health effect. Smoking is the largest cause ofpreventable death in the United States. Diseases linked to it kill more than 480,000 Americansa year.
在美國(guó)，吸煙是可預(yù)防性死亡的首要原因。每年因吸煙相關(guān)疾病致死的美國(guó)人超過(guò)48萬(wàn)人。因此，哪怕是吸煙率的小小降低也將帶來(lái)巨大的健康效應(yīng)。
