Financial Incentive Could Help Pregnant Women Stop Smoking

Zarrin Hossain

December 07, 2021

Smoking during pregnancy is a major health concern for the mother and the unborn child leading to negative birth outcomes which can then develop later in life. Evidence suggests that less than half of women who are daily smokers before pregnancy find it difficult to quit once pregnant, but offering a financial incentive to help tackle this problem, according to a study published in  The BMJ .

A single, blind, Financial Incentive for Smoking Cessation in Pregnancy (FISCP) trial involving a total of 460 pregnant smokers from 18 maternity wards was conducted by researchers in France.

Those who smoked five or fewer cigarettes per day or three or less roll-your-own cigarettes per day, and who were 18 weeks or less into pregnancy were included. The average age of participants was 29 years. Out of the 460 participants, 231 women were randomly assigned to a financial incentives group and 229 to a control group.

Both groups took part in six 10-minute, face-to-face visits where they received counselling and were given support to prevent relapse, as well as set an achievable date they wish to stop smoking. At the end of each visit, the control group received vouchers worth £17 but no financial incentive was given if they restrained themselves from smoking, so the maximum amount they earned was around £102.

Participants in the financial incentives group, however, did receive a reward if they abstained from smoking and earned vouchers of up to £442. At the start of each visit, the participant’s breath was measured for carbon monoxide levels.

Outcome Measures

The main outcome measure was continuous smoking abstinence from the first post-quit date to visit 6, before delivery. Secondary outcomes in Secondary outcomes in the mothers were point prevalence abstinence, time to smoking relapse, withdrawal symptoms, blood pressure, and alcohol and cannabis use in past 30 days. Secondary outcomes in the babies were gestational age at birth, birth characteristics (birth weight, length, head circumference, Apgar score), and a poor neonatal outcome - a composite measure of transfer to the neonatal unit, congenital malformation, convulsions, or perinatal death.

The researchers found that a higher number of participants who received a financial incentive abstained from smoking compared to those who didn’t receive a reward – 16% vs 7%, (OR 2.45: 95% CI 1.34 to 4.49, P=0.004). On average, 163 fewer cigarettes were smoked in the financial incentives group compared to the control.

Tobacco cravings was also significantly lower for participants who received a financial incentive (95% CI -3.55 to -0.08, P=0.04) as was median time to relapse.

In addition, there was a 7% reduction in the risk of poor neonatal outcomes observed in the financial incentive group. No significant difference was found for secondary outcome measures for the mothers.

The number of babies with a birth weight 2500 g or higher, a factor which has not been analysed in previous studies, was also shown to be greater in those who received a financial reward. However, the researchers state that "these results should be interpreted with caution."

Nevertheless, the researchers conclude that the financial incentives "could be implemented as a safe and effective intervention to help pregnant smokers quit smoking".

It was also shown in the financial incentives group that the smoking rate of the participant’s partners was as high as 72% compared to 73% in the control group.

"Exposure to second-hand tobacco smoke during pregnancy, regardless of whether the mother smokes, is associated with an increased risk of smoking related negative health concerns," said the researchers.

The researchers suggest that "future studies should assess the efficacy of financial incentives in helping the partners of pregnant smokers to quit smoking" but also "compare the efficacy of incentives or contingency management with that of nicotine replacement therapy."

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