A Randomized Controlled Trial of Financial Incentives to Low Income Pregnant Women to Engage in Smoking Cessation Treatment: Effects on Post-Birth Abstinence

• Published in: Journal of consulting and clinical psychology 2018-05, Vol.86 (5), p.464-473
• Main Authors: Baker, Timothy B, Fraser, David L, Kobinsky, Kate, Adsit, Robert, Smith, Stevens S, Khalil, Lisette, Alaniz, Kristine M, Sullivan, Tingting E, Johnson, Mimi L, Fiore, Michael C
• Format: Article
• Language: English
• Subjects: Abstinence; Adult; Childbirth & labor; Clinical research; Clinical trials; Counseling; Counseling - economics; Domiciliary visits; Drug Abstinence; Female; Financial incentives; Human; Humans; Low income groups; Lower Income Level; Medicaid; Monetary Incentives; Motivation; Payments; Perinatal; Perinatal care; Postpartum Period - psychology; Poverty; Pregnancy; Pregnancy complications; Pregnant Women - psychology; Recruitment; Smokers - psychology; Smoking; Smoking - psychology; Smoking Cessation; Smoking Cessation - methods; Smoking Cessation - psychology; Smoking Prevention - methods; Support services; Treatment Effectiveness Evaluation; Treatment Outcome
• ISSN: 0022-006X; 1939-2117; 1939-2117
• DOI: 10.1037/ccp0000278

Objective: Evaluate the effectiveness of monetary incentives for increasing engagement in smoking cessation treatment and improving 6-month abstinence in low-income pregnant smokers. Method: Two-group randomized clinical trial recruiting low-income (Medicaid-registered) pregnant smokers receiving assistance through a perinatal support program. Participants were randomized to either an incentive (n = 505) or control condition (n = 509). All participants were offered identical smoking cessation counseling at contacts. Incentive condition participants received incentives for attending pre- and postbirth treatment contacts: $25 for each of 6 prebirth provider visits, $25-40 for each of 4 postbirth home visits at Weeks 1, 2, 4, and 6 (total = $130), $20 for each of 5 postbirth counseling calls and $40 for biochemically verified abstinence at the Week 1 and 6-month visits. Control condition participants received only $40 for attendance at the Week 1 and 6-month postbirth visits ($40 each). Main outcomes: Primary outcome was biochemically confirmed 7-day point-prevalence abstinence at 6-month postbirth follow-up. Secondary outcomes included number of home visits and phone calls taken over the first 6 months postbirth; biochemically confirmed abstinence at postbirth Week 1 visit; and self-reported smoking status at 2- and 4-month visits. Results: Incentive condition participants had a higher biochemically confirmed abstinence rate at 6-month postbirth than controls (14.7% vs. 9.2%, respectively: p < .01). This effect was mediated by incentive condition participants' greater acceptance of postbirth home visits and counseling calls. Conclusions: Moderate incentive payments for smoking treatment engagement (a mean of ≈$214 paid) increased low-income pregnant smokers' engagement and success in smoking cessation treatment. What is the public health significance of this article? Smoking during and after pregnancy has serious health consequences for mothers and infants. Low-income women are especially likely to smoke during pregnancy or resume smoking after it, making it vital to develop an intervention that increases long-term postbirth abstinence and that is suitable for widespread use. This research shows that modest financial incentives for engagement in smoking cessation treatment increased new mothers' attendance at postbirth treatment contacts and increased their smoking abstinence at a 6-month postbirth visit.