Evidence Tools
MCHbest. NPM 14.1: Smoking in Pregnancy
Strategy. Incentives
Approach. Provide incentives to reduce smoking during pregnancy.
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Overview. Interventions that offer material incentives in efforts to change behavior — whether in the form of cash, vouchers, discounts, gift cards, or baby products — have proven to be effective in encouraging pregnant smokers to quit.1,2,3,4,5 Evidence from recent studies build on earlier findings that support both the efficacy and cost-effectiveness of contingency-based financial incentives as a smoking deterrent. Not only are such incentives effective in reducing the number of pregnant women who smoke, but the cost of such interventions is comparable to other effective smoking-cessation interventions already in use.6
Evidence. Scientifically Rigorous. There is strong evidence that contingency-based incentives, combined with standard care, is likely to increase the likelihood of quitting among pregnant women who smoke, compared with those who receive the standard care only. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).
Target Audience. Pregnant women who smoke.
Outcomes.Smoking cessation during pregnancy. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.
Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.
Sample ESMs. Using the approach “Provide incentives to reduce smoking during pregnancy,” here are sample ESMs you can use to model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):
- Number of pregnant women who receive incentives to quit smoking.
- Percent of pregnant women who report that incentives provided added motivation to quit smoking.
- Number of pregnant women who report a readiness to quit smoking after receiving incentives
- Percent of pregnant women who quit or reduce smoking due to incentives.
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Note. When looking at your ESMs, SPMs, or other strategies: (1) move from measuring quantity to quality; (2) move from measuring effort to effect; (3) Quadrant 1 strategies should be used sparingly, when no other data exists; and (4) the most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.
Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.
Reference:
1 Lopez AA, Skelly JM, White TJ, Higgins ST. Does impulsiveness moderate response to financial incentives for smoking cessation among pregnant and newly postpartum women? Experimental and Clinical Psychopharmacology 2015;23:97-108
2 Olson AL, Boardman MB, Johnson DJ. Smoke-free moms: Financial rewards for smoking cessation by low-income rural pregnant women. American Journal of Preventive Medicine 2019 Apr 17. Pii:S0749-3797(19)30085-6.
3 Tappin D, Bauld L, Purves D, Boyd K, Sinclair L, MacAskill S, et al. Financial incentives for smoking cessation in pregnancy: Randomised controlled trial. British Medical Journal 2015;350:Art g134-12.
4 Wen X, Eiden RD, Justicia-Linde FE, Wang Y, Higgins ST, Thor N, Haghdel A, Peters AR, Epstein LH. A multicomponent behavioral intervention for smoking cessation during pregnancy; A noncurrent multiple-baseline design. Translational Behavioral Medicine 2019 Mar 1;9(2):308-318.
5 Zvorskey IA, Lopez AA, White TJ, Skelly JM, Higgins ST. Psychiatric symptoms among pregnant and newly postpartum women receiving financial incentives for smoking cessation. Drug & Alcohol Dependence 2015 Nov,156:e245.
6 Boyd KA, Briggs AH, Bauld L, et al. Are financial incentives cost-effective to support smoking cessation during pregnancy? Addiction. 2015 Sep 15; Seminal study supporting the cost-effectiveness of financial incentives for smoking cessation with pregnant and newly postpartum women.