Can giving a pregnant person substantial financial incentive to quit smoking improve verified cessation?
Providing graduated financial incentives to older, multiparous pregnant persons doubles the rate of not smoking throughout the pregnancy (27% vs 12%). However, almost all patients will start smoking again within 6 months after delivery.
Randomized controlled trial (single-blinded)
These researchers identified 944 pregnant persons who reported current smoking at the first maternity visit. Almost all of the enrolled participants were white (98%), with an average age of 28 years with an average of 2 previous live births. Almost half (43%) were in the "most deprived" category (a measure of poverty). All participants were offered stop smoking services commonly provided in the United Kingdom, including counseling and nicotine replacement. In addition, the patients were randomized, using concealed allocation, to receive up to £400 ($540, €480) at 4 intervals. They were offered £50 to start the program, another £50 if they were not smoking at 4 weeks, £100 if not smoking at 12 weeks, and another £200 if smoke-free at 34 to 38 weeks. Smoking status was verified by exhaled carbon monoxide and confirmed by saliva sampling. Pregnancy-long cessation occurred in 27% of participants receiving the incentive and in 12% of participants in the control group (P < .001). Pregnancy-related outcomes were similar in both groups, though the study was too small to find small differences. Six months postpartum, most women in both groups were smoking again (94% and 96.4 %).
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine