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Quitting Smoking in 2021 Takes Heart and Soul ... and a Little Nudge

Updated: Jun 4, 2021

If you’ve ever had an addictive habit, you know it can be hard to break. If that habit has been tobacco, you also know how breaking that habit challenges you to the very core of your being. Addictions to tobacco are amongst the hardest to quit. Chronic tobacco use grips the user physically via nicotine dependence, psychologically via triggers and repetition, socially via relationship hijacking, culturally through traditions and norms, and emotionally via companionship and filling a void.

Tobacco has been used by people in the Americas for eight thousand years. In 1964, when the landmark US Surgeon General’s study was published linking smoking with heart disease and lung cancer, 42% of US adults smoked cigarettes (National Center for Health Statistics 2005). Since then, public health initiatives have worked tirelessly to reduce adult smoking prevalence to 14% by 2019. Annual reporting, mass media campaigns, higher tobacco taxes, and public space restrictions, along with shifting public perception and declining social acceptance, were the driving forces. Fifty-five years of intense collaborative effort was working. However, despite tobacco users being at higher risk for severe Covid-19 during the 2020 coronavirus pandemic, tobacco purchases rose again. High levels of stress and uncertainty, along with people feeling isolated and working from home, have temporarily overwhelmed our cessation efforts. New approaches are needed.

Enter Vincere Health.

Launched a little over 2 years ago in the Harvard Innovation Labs, Vincere Health is a virtual care delivery model designed to help people quit or reduce their tobacco use by blending remote health monitoring, behavioral nudges, and financial incentives with a mobile app and human coaching. Founded by Jacob Keteyian, MPH ’19, Shalen De Silva, MPH ’19, Hadi Javeed, CTO, and Trevor Campbell, Head of Product, Vincere Health received the $75k grand prize in the Launch Lab X (Alumni) Track of the 2020 Harvard President’s Innovation Challenge.

Vincere’s flagship program, EARN — Engage, Adopt, Reward, Nurture — is getting high grades from strategic partners and individual participants alike. Baby And Me Tobacco Free, a large academic medical center, and other partners are seeing higher engagement, customer satisfaction, and harm reduction metrics. For example:

  • Net Promoter Score (NPS) for Vincere Health participants: 82%

  • Net Promoter Score (NPS) for academic medical center employees: 100%

  • Healthy birth weights for women served in the prenatal period: 89%

  • Reduction in CO PPM for Vincere Health participants: 68%

  • Average weekly clinical trial touch points: 7.4

E A R N represents the four phases of the Vincere Health program.

Engage is the incubator space where people learn about the program, get their questions answered, and enroll.

Adopt is the first week when participants receive their QuitKits and are invited to practice their new CO monitoring and tracking habits and build rapport with their coach. New Participants receive reminders on their mobile app to do daily breath tests and attend coaching sessions. Engagement is measured based on habit compliance.

Reward is the growth phase, 7 to 11 weeks of goal setting, problem solving, and step-by-step progress. Participants are encouraged to set compelling yet reachable weekly goals and CO targets and stay connected to their coaches for support via Vincere’s proprietary audio video platform.

Nurture is offered to all graduates of Reward, a peer community of other habit changers that aims to foster and sustain a new healthier lifestyle.

Vincere recognizes that not everyone is ready to quit and has designed their care delivery approach with this in mind. Unlike quitlines and other state-funded initiatives, Vincere invites people into EARN even when they’re not ready to set a quit date. Contemplating a quit attempt or simply wishing to cut down, along with a willingness to do some easy carbon monoxide (CO) breath tests, are all that’s needed. Stages of change are seldom a neat and tidy set of readiness steps, and Vincere’s change model and team MEET PEOPLE WHERE THEY ARE.

What also sets Vincere Health apart is their heart-driven mission and relentless pursuit of helping those most in need. While their solution is available to eligible adults—often covered by insurance but also available out-of-pocket—it is most targeted toward the underserved among us. A higher percentage of Medicaid recipients smoke than the overall population, 24.5% versus 14%, and make up the majority of Vincere’s participant community. They often wish to quit, for both health and financial reasons, but lack the resources and support to succeed. The EARN program offers them a bit of external motivation in the form of behavioral incentives and weekly support touchpoints with their dedicated health coach as they slowly reduce their CO via remote daily breath testing. This extra motivation, in combination with real-time evidence of physical harm from smoking, helps to activate a brewing desire to break free from the grips of tobacco. Small micromovements of change translate over time to a confidence-inducing momentum that buoys hope and optimism. While participants learn to extinguish an entrenched coping mechanism, Vincere strives to inspire the adoption of new healthier alternatives. It’s proving to be a powerful blend of motivational nudges, data insights, and human connection.

To learn more, visit

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