Financial incentives for smoking cessation in pregnancy: a single-arm intervention study assessing cessation and gaming.
OBJECTIVE
Financial incentives were the single most effective intervention for smoking cessation in pregnancy in a recent Cochrane Review, but based on a few small trials in the United States using only 7-day point prevalence measures of cessation. This study estimates (a) prolonged cessation in an unselected population of English pregnant smokers who are offered financial incentives for quitting and (b) 'gaming', i.e. false reporting of smoking status to enter the scheme or gain an incentive.


METHODS
Single-arm intervention study


METHODS
Antenatal clinic and community


METHODS
A total of 239 pregnant smokers enrolled into the financial incentive scheme, attending for maternity care at one hospital in an area of high deprivation in England over a 42-week period.


METHODS
Smoking cessation at delivery and 6 months postpartum, assessed using salivary cotinine; gaming assessed using urinary and salivary cotinine at enrolment, 28 and 36 weeks gestation, and 2 days and 6 months postpartum.


RESULTS
Thirty-nine per cent (239 of 615) of smokers were enrolled into the scheme, 60% (143 of 239) of whom made a quit attempt. Of those enrolled, 20% [48 of 239; 95% confidence interval (CI) = 14.9%, 25.1%] were quit at delivery and 10% (25 of 239; 95% CI = 6.2%, 13.8%) at 6 months postpartum. There was no evidence that women gamed to enter the scheme, but evidence that 4% (10 of 239) of those enrolled gamed on one or more occasions to gain vouchers.


CONCLUSIONS
Enrolment on an incentive scheme in an unselected English cohort of pregnant smokers was associated with prolonged cessation rates comparable to those reported in US trials. Rates of gaming were arguably insufficiently high to invalidate the use of such schemes.
Centre for the Study of Incentives in Health, King's College London, London, UK.
Diana
D
Ierfino
Eleni
E
Mantzari
Julie
J
Hirst
Tina
T
Jones
Paul
P
Aveyard
Theresa M
TM
Marteau
D000328:Adult; D003367:Cotinine / Q000032:analysis / Q000652:urine; D008192:Deception; D004739:England; D005260:Female; D006801:Humans; D009042:Motivation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D012463:Saliva / Q000737:chemistry; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D055815:Young Adult
D003367:Cotinine
Financial incentives; gaming; pregnancy; smoking; smoking cessation; vouchers