Randomized clinical trial examining financial incentives for smoking cessation among mothers of young children and possible impacts on child secondhand smoke exposure

Abstract

This randomized clinical trial examined whether financial-incentives increase smoking cessation among mothers of young children and potential impacts on child secondhand-smoke exposure (SHSe). 198 women-child dyads were enrolled and assigned to one of three treatment conditions: best practices (BP, N = 68), best practices plus financial incentives (BP + FI, N = 63), or best practices, financial incentives, and nicotine replacement therapy (BP + FI + NRT, N = 67). The trial was completed in Vermont, USA between June 2015 and October 2020. BP entailed staff referral to the state tobacco quitline; financial incentives entailed mothers earning vouchers exchangeable for retail items for 12 weeks contingent on biochemically-verified smoking abstinence; NRT involved mothers receiving 10 weeks of free transdermal nicotine and nicotine lozenges/gum. Baseline, 6-, 12-, 24-, and 48-week assessments were conducted. Primary outcomes were maternal 7-day point-prevalence abstinence and child SHSe through the 24-week assessment with the 48-week assessment exploratory. Results were analyzed using mixed model repeated measures for categorical data. Odds of maternal abstinence were greater among mothers in BP + FI and BP + FI + NRT compared to BP at the 6- and 12-week assessments (ORs ≥ 7.30; 95% CIs: 2.35-22.71); only abstinence in BP + FI remained greater than BP at the 24-week assessment (OR = 2.95; 95% CIs: 1.06-8.25). Abstinence did not differ significantly between treatment conditions at the 48-week assesssment. There was a significant effect of treatment condition (F[2109] = 3.64, P = .029) on SHSe with levels in BP and BP + FI significantly below BP + FI + NRT (ts[109] ≥ -2.30, Ps ≤ 0.023). Financial incentives for smoking abstinence are efficacious for increasing maternal cessation but that alone was insufficient for reducing child SHSe. ClinicalTrials.gov:NCT05740098.

Keywords: Best practices; Financial incentives; Mothers; Nicotine replacement therapy; Secondhand smoke exposure; Smoking cessation; Women.

Figure 1.

Consort diagram of trial enrollment.

Figure 2.

Shown are the percent of mothers biochemically confirmed to have achieved seven-day point-prevalence smoking abstinence during the intervention (6-week, 12-week) and follow-up (24-week, 24-week) periods (upper panel) and the percent biochemically confirmed to have sustained smoking abstinence across consecutive assessments (lower panel) among those randomly assigned to best practices alone (BP, best practices plus financial incentives (BP + FI), or best practices plus financial incentives plus combined short- and long-acting nicotine replacement therapy (BP + FI + NRT) across the 6-, 12-, (end-of-treatment), 24- (follow-up), and 48-week (exploratory follow-up) assessments. Note: data points not sharing a superscript letter differ significantly at P<.05.

Figure 3.

Shown are mean geometric urine cotinine levels during weeks 6–24 among children of mothers randomly assigned to best practices alone (BP, best practices plus financial incentives (BP + FI), or best practices plus financial incentives plus combined short- and long-acting nicotine replacement therapy (BP + FI + NRT). Note: data points not sharing a superscript letter differ significantly at P<.05.