Financial incentives for smoking cessation among depression-prone pregnant and newly postpartum women: effects on smoking abstinence and depression ratings

Abstract

Introduction: We examined whether pregnant and newly postpartum smokers at risk for postpartum depression respond to an incentive-based smoking-cessation treatment and how the intervention impacts depression ratings.

Methods: This study is a secondary data analysis. Participants (N = 289; data collected 2001-2013) were smokers at the start of prenatal care who participated in 4 controlled clinical trials on the efficacy of financial incentives for smoking cessation. Women were assigned either to an intervention wherein they earned vouchers exchangeable for retail items contingent on abstaining from smoking or to a control condition wherein they received vouchers of comparable value independent of smoking status. Treatments were provided antepartum through 12-weeks postpartum. Depression ratings (Beck Depression Inventory [BDI]-1A) were examined across 7 antepartum/postpartum assessments. Women who reported a history of prior depression or who had BDI scores ≥ 17 at the start of prenatal care were categorized as depression-prone (Dep+), while those meeting neither criterion were categorized as depression-negative (Dep-).

Results: The intervention increased smoking abstinence independent of depression status (p < .001), and it decreased mean postpartum BDI ratings as well as the proportion of women scoring in the clinical range (≥17 and >21) compared with the control treatment (ps ≤ .05). Treatment effects on depression ratings were attributable to changes in Dep+ women.

Conclusions: These results demonstrate that depression-prone pregnant and newly postpartum women respond well to this incentive-based smoking-cessation intervention in terms of achieving abstinence, and the intervention also reduces the severity of postpartum depression ratings in this at-risk population.

Figure 1.

Proportion of women abstinent from smoking by treatment condition at each assessment in the overall sample (panel A), among depression-prone (Dep+) women (panel B), and among depression-negative (Dep−) women (panel C).

Figure 2.

Effects of the interaction of treatment condition (contingent intervention and noncontingent control), depression status (Dep+ and Dep−), and assessment time on mean BDI total scores. Error bars represent ± 1 SEMs.

Figure 3.

Mean change scores from the intake assessment in mean BDI total scores among depression-prone (Dep+) women at each assessment time. Error bars represent ± 1 SEMs. *p ≤ .05, **p ≤ .01, and ***p ≤ .001.

Figure 4.

Proportion of depression-prone (Dep+) women meeting criteria for clinically significant BDI scores at all assessments. Results from women with scores suggesting mild or greater (≥17) and moderate or greater (>21) depression levels are shown in panels A and B, respectively. *p ≤ .05; **p ≤ .01.