Examining two different schedules of financial incentives for smoking cessation among pregnant women

Stephen T Higgins; Yukiko Washio; Alexa A Lopez; Sarah H Heil; Laura J Solomon; Mary Ellen Lynch; Jennifer D Hanson; Tara M Higgins; Joan M Skelly; Ryan Redner; Ira M Bernstein

doi:10.1016/j.ypmed.2014.03.024

Examining two different schedules of financial incentives for smoking cessation among pregnant women

Prev Med. 2014 Nov:68:51-7. doi: 10.1016/j.ypmed.2014.03.024. Epub 2014 Apr 2.

Authors

Affiliations

¹ Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA. Electronic address: Stephen.Higgins@uvm.edu.
² Department of Psychiatry, University of Vermont, USA.
³ Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
⁴ Department of Family Practice, University of Vermont, USA.
⁵ Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA.
⁶ Department of Medical Biostatistics, University of Vermont, USA.
⁷ Vermont Center on Behavior and Health, University of Vermont, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, USA.

Abstract

Objective: To examine whether an efficacious voucher-based incentives intervention for decreasing smoking during pregnancy and increasing fetal growth could be improved without increasing costs. The strategy was to redistribute the usual incentives so that higher values were available early in the quit attempt.

Method: 118 pregnant smokers in greater Burlington, Vermont (studied December, 2006-June, 2012) were randomly assigned to the revised contingent voucher (RCV) or usual contingent voucher (CV) schedule of abstinence-contingent vouchers, or to a non-contingent voucher (NCV) control condition wherein vouchers were provided independent of smoking status. Smoking status was biochemically verified; serial sonographic estimates of fetal growth were obtained at gestational weeks 30-34.

Results: RCV and CV conditions increased point-prevalence abstinence above NCV levels at early (RCV: 40%, CV: 46%, NCV: 13%, p=.007) and late-pregnancy (RCV: 45%; CV: 36%; NCV, 18%; p=.04) assessments, but abstinence levels did not differ between the RCV and CV conditions. The RCV intervention did not increase fetal growth above control levels while the CV condition did so (p<.05).

Conclusion: This trial further supports the efficacy of CV for increasing antepartum abstinence and fetal growth, but other strategies (e.g., increasing overall incentive values) will be necessary to improve outcomes further.

Trial registration: ClinicalTrials.gov NCT01801384.

Keywords: Birth outcomes; Contingency management; Fetal growth; Financial incentives; Pregnancy; Smoking cessation; Tobacco; Vouchers.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Analysis of Variance
Birth Weight
Female
Fetal Development
Humans
Infant, Newborn
Motivation
Pregnancy
Pregnancy Outcome
Pregnant Women / psychology*
Smoking / economics*
Smoking / epidemiology
Smoking Cessation / economics*
Smoking Cessation / methods*
Smoking Prevention*
Surveys and Questionnaires
Treatment Outcome
Ultrasonography
Vermont / epidemiology
Young Adult

Associated data

ClinicalTrials.gov/NCT01801384

Abstract

Publication types

MeSH terms

Associated data

Grants and funding