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


METHODS
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).


CONCLUSIONS
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.
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.
Stephen T
ST
Higgins
Department of Psychiatry, University of Vermont, USA.
Yukiko
Y
Washio
Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
Alexa A
AA
Lopez
Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
Sarah H
SH
Heil
Department of Family Practice, University of Vermont, USA.
Laura J
LJ
Solomon
Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA.
Mary Ellen
ME
Lynch
Department of Psychiatry, University of Vermont, USA.
Jennifer D
JD
Hanson
Department of Psychiatry, University of Vermont, USA.
Tara M
TM
Higgins
Department of Medical Biostatistics, University of Vermont, USA.
Joan M
JM
Skelly
Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA.
Ryan
R
Redner
Vermont Center on Behavior and Health, University of Vermont, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, USA.
Ira M
IM
Bernstein
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001724:Birth Weight; D005260:Female; D047109:Fetal Development; D006801:Humans; D007231:Infant, Newborn; D009042:Motivation; D011247:Pregnancy; D011256:Pregnancy Outcome; D037841:Pregnant People / Q000523:psychology*; D012907:Smoking / Q000191:economics* / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods*; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014463:Ultrasonography; D014707:Vermont / Q000453:epidemiology; D055815:Young Adult
Birth outcomes; Contingency management; Fetal growth; Financial incentives; Pregnancy; Smoking cessation; Tobacco; Vouchers