Financial incentives improve smoking cessation among pregnant women

Pregnant women were more likely to adhere to smoking abstinence if they received financial incentives as part of their treatment plan, according to findings published in The BMJ.

“Financial incentives rewarding smoking abstinence compared with no financial incentives were associated with significantly increased continuous and point prevalence abstinence rates, a prolongation in the time to relapse, and a reduction in craving for tobacco,” Ivan Berlin, MD, PhD, an associate professor of clinical pharmacology at Pitié-Salpêtrière Hospital and Sorbonne University in Paris, and colleagues wrote.

Berlin and colleagues enrolled 460 adult pregnant women in France who smoked at least five cigarettes or three roll-your-own cigarettes per day in a multicenter, randomized controlled trial between April 2016 and July 2019. The women were enrolled at fewer than 18 weeks of gestation and followed for 12 months. They were randomly assigned to the financial incentives intervention group or the control group. Of the 460 participants, 40% reported a low income.

All participants, including those in the control group, received at least 10 minutes of motivational counseling for smoking cessation and a 20 voucher (equivalent to approximately $23) for attendance at each of six visits. The 231 participants in the intervention group received progressively increasing vouchers at each study visit they remained abstinent. However, abstinence was not rewarded in the control group. Participants in the intervention group could earn as much as 520 ($585) overall if they remained continuously abstinent. Berlin and colleagues determined abstinence using self-reports of no smoking during the previous week and by measuring participants’ carbon monoxide breath levels with a Bedfont Smokelyzer piCO, which needed to be 8 ppm or less.

Smoking abstinence and newborn health

Overall, participants in the financial incentives group earned 49,040 in vouchers compared with 19,520 in the control group.

Women in the intervention group smoked 163 fewer cigarettes than those in the control group, according to the researchers. Also, 16% of participants who received financial incentives were continuously abstinent compared with 7% of participants in the control group (OR = 2.45; 95% CI, 1.34-4.49).

The median time to relapse occurred significantly later among those in the intervention group (visit five) compared with the control group (visit four). Moreover, participants who received incentives experienced fewer cravings for tobacco throughout their pregnancy ( = 1.81; 95% CI, 3.55 to 0.08).

Berlin and colleagues found that significantly fewer women in the financial incentives group had a newborn with poor neonatal outcomes compared with the control group (2% vs. 9%). However, the smoking rate of all participants’ partners was high in both groups (72% in the intervention group and 73% in the control group), which likely exposed the participants to secondhand smoke, according to the researchers.

“Financial incentives dependent on smoking abstinence could be implemented as a safe and effective intervention to help pregnant smokers quit smoking,” Berlin and colleagues wrote.

Implementing financial incentives into practice

In a related editorial, Leonieke J. Breunis, MD, a researcher in the department of obstetrics and gynecology at Erasmus MC Sophia Children’s Hospital in the Netherlands, and colleaguesadvocated for the implementation of smoking cessation incentives among pregnant women in standard practice.

“Integration of incentives in national best practice guidelines and determining responsibility for implementation, service provision and cost coverage will be important in shaping national and local strategies,” they wrote.

They added that implementation of this intervention will “play an important role in reducing health inequalities at their earliest origin.”

References:

Berlin I, et al. BMJ. 2021;doi:10.1136/bmj-2021-065217.

Breunis LJ, et al. BMJ. 2021;doi:10.1136/bmj.n2889.