Reducing Smoking with Financial Incentives in East Timor (2025-2026)
Please note that this is a joint Duke-DKU team that will include faculty and students from both institutions. Applicants should be excited to work collaboratively across institutions and should expect to coordinate meetings across time zones.
Background
East Timor is the poorest country in Asia and has the highest smoking rates in the world. The World Health Organization estimates that more than 60% of males (about 40% of individuals overall) aged 15 years and older are current tobacco users. As noncommunicable diseases become more prevalent in low- and middle-income countries (LMICs), efforts to reduce smoking are gaining momentum, but most interventions have focused on education about health risks, with results showing limited effectiveness.
Thus far, the strategy of incentivizing young adults to reduce smoking in LMICs has been overlooked, despite the fact that conditional cash transfers aimed at alleviating household poverty and promoting maternal and child health have been widely successful in these nations. Meanwhile, directly targeting smoking with incentives is common in high-income countries such as the U.S. The consistent positive results from this approach suggest this is a missed opportunity for LMICs that could both help reduce the health burden and supplement households’ income.
Project Description
This project team will conduct a feasibility study testing financial incentives and education to reduce smoking in young adults (18-24 years old) with the following goals: 1) reduce smoking rates during the four-week intervention period; 2) reduce smoking rates in the two-month follow-up period; and 3) explore potential spillover effects, both positive and negative, prompted by the intervention. These spillover effects will be assessed with two focus groups exploring views on tobacco and smoking in the wider community, as well as perceptions about the effectiveness and acceptability of using incentives to reduce smoking.
The team will work in partnership with the National Alliance for Tobacco Control (a coalition of 11 NGOs), 13 youth centers and the National University of East Timor. Team members will be divided into three subteams: one dedicated to literature review; one dedicated to the randomized controlled trial; and one dedicated to focus groups. Their research will provide pilot data for future grant proposals.
Anticipated Outputs
Peer-reviewed articles; online data repository; pilot data for future grant proposal; project website; educational workshop in East Timor for community leaders to disseminate project results back to the community
Student Opportunities
Ideally, this project team will include 3 graduate students and 6 undergraduate students interested in fields such as global health, health psychology, public policy, behavioral economics and sustainable development. Regardless of their field, students should have (or be willing to develop) strong project management, research and communication skills. Students should also be interested in global perspectives on health behaviors and social determinants of health.
Please note that this is a joint Duke-DKU team that will include faculty and students from both institutions. Applicants should be excited to work collaboratively across institutions and should expect to coordinate meetings across time zones.
In Fall 2025, the team will meet on Fridays at 9 a.m. Each subteam will be led by a graduate student and will report to the full group biweekly.
This project will nurture students’ sense of global citizenship and intercultural competency. Students will learn how to conduct a high-quality literature review; how to design, prepare and implement field studies in LMICs; how to approach and support stakeholders and participants; and how to communicate to broader audiences the results of scientific research. Graduate students will gain leadership experience by mentoring undergraduates and supervising specific project components.
Timing
Fall 2025 – Spring 2026
- Fall 2025: Perform literature review; support design of randomized controlled trial
- Spring 2026: Support implementation of randomized controlled trial; analyze results of focus groups
Crediting
Academic credit available for fall and spring semesters