Smoking in pregnancy is a leading preventable cause of maternal and neonatal illness and death in developed countries. In the UK alone, around 5000 fetuses and babies die from smoking during pregnancy each year. Current interventions are not particularly effective.
Smoking in pregnancy can cost the NHS up to £64 million for problems in mothers and up to £23.5 million for infants.
David Tappin at the University of Glasgow, Linda Bauld at the University of Stirling and colleagues assessed whether financial incentives motivate pregnant women to quit smoking. In total, 612 pregnant smokers were randomly assigned to one of two groups.
Half were assigned to a group offered up to £400 of financial incentives if they engaged with ‘usual care’ smoking cessation services and or quit smoking during pregnancy. The other half were offered usual care smoking cessation services that included a face to face appointment with a smoking cessation adviser, four follow-up support calls and free nicotine replacement therapy for 10 weeks.
Women who were offered shopping vouchers were significantly more likely to quit smoking than those in the control group. Overall, 69 women quit from the test group, and 26 from the control group-23% and 9% respectively. This was confirmed by cotinine (a nicotine breakdown product) in urine or saliva.
After 12 months, 15% of women who were offered financial incentives remained off cigarettes compared to only 4% in the control group.
No harmful effects were reported from the test group and there was no suggestion of “gaming”.
“This study provides substantial evidence of a very promising and potentially cost-effective new intervention to add to present health service support,” write the authors. “The findings can serve as the basis for future research to include other UK centres and other health care systems,” they say.
The authors also add that there is potential for financial incentives to “sit with vaccines as an important preventative healthcare intervention strategy.” Stopping mothers from smoking has a ripple effect on the health of their children, and providing income to poor families can help to reduce inequalities, they explain.
Furthermore they point out that “it is important to note that this is only a trial, in the future we are looking to develop a multicentre study to test whether the idea of incentive works in different types of smoking cessation centres around the UK.”
Research: Professor David Tappin, PEACH unit, Child Health, Glasgow University, Scotland.
Tel: 0778 430 4568
Professor Linda Bauld, UK Centre for Tobacco and Alcohol Studies, School of Health Sciences, Stirling University, Scotland.
Tel: 07714 213 372 / 01786 467347 (personal assistant)