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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Smoking During Pregnancy.

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Strategy. Incentives (Pregnancy)

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, for 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 Evidence. Strategies with this rating are most likely to be effective...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Incentive distribution and recipient characteristics data
  • Engagement data in smoking cessation activities
  • Survey data on participant satisfaction and perceived value of incentives

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Community Health Factors.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of prenatal care sites offering financial incentives for smoking cessation. (Measures program availability)
  • Number of pregnant women who smoke enrolled in the incentive program. (Measures program reach)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of incentive program protocols that align with best practices for contingency management. (Measures program quality)
  • Percent of program staff trained in nonjudgmental, competent participant interactions. (Measures staff preparedness)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of referrals to the incentive program from WIC, home visiting, for other social programs. (Measures cross-program integration)
  • Number of earned media stories for social media posts promoting the incentive program's successes. (Measures public awareness efforts)
  • Number of program participants who achieve at least 1 month of biochemically verified abstinence. (Measures short-term cessation success)
  • Number of adverse birth outcomes potentially averted based on the program's quit rates. (Measures health impact)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of the eligible population in targeted communities enrolled in the incentive program. (Measures reach of participation)
  • Percent of program communications tailored for pregnant women with lower incomes. (Measures tailored, appropriate outreach)
  • Percent decrease in smoking prevalence during pregnancy among Medicaid enrollees. (Measures impact on reducing gaps)
  • Percent of participants reporting that the incentives alleviate financial stress as a challenge to quitting. (Measures impact on motivating factors)

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.
  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.

References

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.

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.