Financial incentives for smoking cessation among pregnant and newly postpartum women

Abstract

Objective: Smoking during pregnancy is the leading preventable cause of poor pregnancy outcomes in the U.S., causing serious immediate and longer-term adverse effects for mothers and offspring. In this report we provide a narrative review of research on the use of financial incentives to promote abstinence from cigarette smoking during pregnancy, an intervention wherein women earn vouchers exchangeable for retail items contingent on biochemically-verified abstinence from recent smoking.

Methods: Published reports based on controlled trials are reviewed. All of the reviewed research was conducted by one of two research groups who have investigated this treatment approach.

Results: Results from six controlled trials with economically disadvantaged pregnant smokers support the efficacy of financial incentives for increasing smoking abstinence rates antepartum and early postpartum. Results from three trials provide evidence that the intervention improves sonographically estimated fetal growth, mean birth weight, percent of low-birth-weight deliveries, and breastfeeding duration.

Conclusions: The systematic use of financial incentives has promise as an efficacious intervention for promoting smoking cessation among economically disadvantaged pregnant and recently postpartum women and improving birth outcomes. Additional trials in larger and more diverse samples are warranted to further evaluate the merits of this treatment approach.

Figure 1

Mean (± SEM) rates of growth in estimated fetal weight (top panel), fetal femur length (bottom left panel), and fetal abdominal circumference (bottom right panel) between ultrasound assessments conducted during the third trimester. Women in the contingent condition received vouchers exchangeable for retail items contingent on biochemically verified smoking abstinence while those in the non-contingent condition received vouchers of comparable value but independent of smoking status. * indicates a significant difference between conditions (p < .05). (From Heil et al., 2008)

Figure 2

Seven-day point-prevalence abstinence at the end-of-pregnancy, 12-, and 24-week postpartum assessments in the contingent (n = 85) and non-contingent (n = 81) treatment conditions. Treatment conditions are the same as described in Figure 1. * indicates a significant difference between conditions (p = .003 or below across the three assessments).

Figure 3

Birth weights of infants born to mothers treated in the contingent (left column, n = 85) and non-contingent (right column, n = 81) treatment conditions. Treatment conditions are the same as described in Figure 1. Each symbol represents an individual infant’s birth weight and the solid line in each column represents the least square mean weight for that condition. The dashed line demarcates the 2500 g cutoff for low birth weight. Mean birth weight differed significantly between treatment conditions (P = .03) as did the percent of low birth weight deliveries (P = .02) (From Higgins et al., 2010b).

Figure 4

Percentage of women who reported breastfeeding at the 2-, 4-, 8-, 12- and 24-week postpartum assessments in the contingent (n = 81) and non-contingent (n = 77) conditions. Treatment conditions are the same as described in Figure 1. Asterisks denote significant differences between treatment conditions with p ≤ .05. (From Higgins et al., 2010a).