Aims and background Since 2004, the Antismoking Center of the National Cancer Institute of Milan has rewarded those who have been ex-smokers for longer than a year with a “former smoker” pin and a diploma. We investigated firstly whether these rewards contributed to maintain smoking withdrawal, secondly, which one of these was more appreciated and why, and thirdly, how they may have influenced the ex-smokers' perception of smoking and how this was reflected on those surrounding them (i.e., ex-smokers' personal and/or interpersonal areas). Methods A multiple-choice questionnaire was developed to investigate how much the rewards were appreciated and their effectiveness in maintaining smoking cessation. Moreover, smokers and non-smokers were asked about the impact of the pin. The questionnaire was completed on the phone by the last 100 ex-smokers who entered the pin and diploma program. Results All subjects appreciated the rewards, but only a few of them considered them as an aid to maintain long-term smoking cessation. Those who preferred the diploma stated that it represented a contribution to their self-esteem, an official recognition of being an ex-smoker, besides being something to show with pride to others. Those who preferred the pin principally stated it allowed them to be an example to other smokers. Most of the subjects reported that they wore the pin in several circumstances, raising interest and admiration. Conclusions Rewarding ex-smokers one year after smoking cessation with a small prize may be a useful practice to improve the doctor-patient relationship, which is vital to maintain smoking cessation, and to boost the awareness of the availability of aids to reach this objective.