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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 14.1: Smoking in Pregnancy

MCHbest Logo paper cutout people holding a used cigarette

Strategy. Incentives

Approach. Provide incentives to reduce smoking during pregnancy.

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Overview. Interventions that offer material incentives in an effort 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. 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 are comparable to other effective smoking-cessation interventions already in use.1

Evidence. Moderate. Research has consistently shown positive results for this smoking-cessation strategy. Providing contingency-based Incentives, combined with standard care, has been tested more than once and the results are positive. The added incentive is likely to increase the likelihood of quitting among pregnant women who smoke, compared with those who receive the standard care only. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Pregnant women who smoke.

Outcome. 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 current 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 as a 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):

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


1 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.


This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.