Financial incentives improve smoking cessation rates in pregnant women

1. A significantly greater number of participants receiving financial incentives reported smoking cessation at 4 weeks as compared to the control group participants when both groups received routine smoking cessation counseling.

2 pregnant smokers need to be offered financial incentives to quit smoking for each additional quitter during 34-38 weeks gestation.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Smoking during pregnancy is associated with an increase in the risk of spontaneous miscarriages, stillbirth, and infant death and is burden on the healthcare system. Smoking abstinence during pregnancy not only prevents premature maternal mortality, but also provides long-term benefits for children. All pregnant women in the United Kingdom are offered smoking cessation counseling, but only 3% maintain abstinence a month after quitting. The purpose of this study was to assess the effect of providing financial incentives in addition to routine smoking cessation counseling on smoking cessation rates in pregnant smokers in Scotland. 612 pregnant smokers were randomized to a control group where they received only routine care and to a study group where they received both routine care and financial incentives (up to £400 of shopping vouchers). The primary outcome assessed was smoking cessation at 34-38 weeks of gestation. It was found that a significantly greater number of study group participants had stopped smoking at 34-38 weeks with an absolute risk difference of 14% for the incentive group.

Future studies will need to validate these findings, especially since this study was conducted at only one center. Further, while the intervention showed promise, financial incentives walk a fine ethical line that needs to be explored more deeply. Regardless, focusing resources on smoking cessation efforts during early pregnancy represents any opportunity to decrease the healthcare burden during pregnancy and of smoking overall.

Click to read the study in the BMJ

Relevant Reading: Incentive interventions for smoking cessation in pregnancy: a mixed methods evidence synthesis

In-Depth [randomized controlled trial]: The purpose of this study was to assess whether financial incentives would increase the rate of smoking cessation in pregnant women. 612 women from Scotland, aged at least 16 years and less than 24 weeks pregnant with confirmed smoking history via exhaled carbon monoxide test, were randomized into a control group and an intervention group. The intervention group received £50 for each smoking cessation appointment they attended in addition to a £50 voucher for quitting and then £100 voucher for maintaining abstinence at 12 weeks for a maximum of £400. The analysis was conducted on a final 306 women were given routine care and 303 who were given the financial incentive in addition to routine care. 69 smokers in the incentive group versus 26 in the control group had stopped smoking at 34-38 weeks (Relative Risk 2.63, CI_95% 1.73 to 4.01) with an absolute risk difference of 14% (CI_95% 8.2-19.7%). The number needed to treat (NNT) was 7.2, where the NNT is the number of pregnant smokers offered financial incentives for each additional quitter. The proportion of patients who relapsed after pregnancy was greater in the control group but many patients from both groups were lost to follow-up.

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