Shopping vouchers help pregnant women quit smoking

Shopping vouchers help pregnant women quit smoking

Offering shopping vouchers worth up to £400 to help quit smoking during pregnancy as a supplement to usual smoking cessation support is extremely effective, says a study published today by the BMJ.

The results show that rewarding pregnant women in this way more than doubled the proportion of those who remained smoke-free by the end of their pregnancy, compared to those who only received usual support, and may save costs for the NHS in the longer term.

However, they also show that most women who quit smoking during pregnancy relapsed six months after the birth of their child.

Smoking during pregnancy is linked to a number of problems, including an increased risk of stillbirth, sudden infant death syndrome, asthma and obesity in offspring.

Although the proportion of women who smoke during pregnancy has halved in the last 20 years, a significant proportion continue to smoke during pregnancy and tend to be harder to reach.

Previous research suggests that financial incentives can promote smoking cessation among pregnant women, but evidence from large UK studies is lacking.

To address this issue, researchers relied on data from a successful Phase 2 feasibility trial in Glasgow, Scotland, to assess whether financial incentives promote smoking cessation during pregnancy when used in combination with current UK smoking cessation services.

Their findings are based on 941 pregnant women (average age 28 years) recruited between January 2018 and April 2020 from seven smoking cessation services in Scotland, Northern Ireland and England.

Participants reported smoking (at least one cigarette in the last week) at their first maternity visit when they were, on average, 11 weeks pregnant. Participants were then randomly assigned to either the intervention group (471) or the control group (470).

The control group was offered standard smoking cessation support, including advice from specially trained staff and free nicotine replacement therapy.

The intervention group was offered usual support as well as shopping vouchers worth up to £400 ($440; €455) to incentivize setting a quit date and remaining abstinent throughout pregnancy.

Abstinence was reported by participants at four and twelve weeks and confirmed by a carbon monoxide breath test. A final voucher was given to those who reported that they were still smoke-free in late pregnancy (between 34 and 38 weeks of gestation), confirmed by a saliva test.

A number of potentially influential factors were taken into account, including mother's age, years of smoking, income, use of nicotine replacement therapy and e-cigarettes, timing of birth and baby's birth weight.

More women in the incentive group (71%) than in the control group (64%) participated in smoking cessation services and set a date for quitting smoking. Saliva tests confirmed that 126 (27%) women in the intervention group had quit smoking by the end of pregnancy, compared with 58 (12%) controls.

However, abstinence rates measured six months after birth were low in both groups (6% in the intervention group versus 4% in the control group), suggesting that most women who quit smoking relapsed not long after the birth of their child.

Overall, the birth weight of babies from 443 intervention participants and 450 controls showed no significant difference between groups (average 3.18 kg vs. 3.13 kg).

The researchers found a clinically meaningful but not significant (10%) increase in birth weight among those who quit smoking when offered incentives and would not have quit smoking without the offer. However, they say further analysis is needed to better understand the relevance of this finding.

The severity of preterm birth was similar in both groups and all serious adverse events such as miscarriage and stillbirth were unrelated to the intervention.

This was a well-designed study, but researchers acknowledge that only 23% of women seen by smoking cessation services were included in the study, which may have overestimated smoking cessation rates in both groups. Additionally, almost all participants were white, so the results may not be applicable to other groups.

However, they say these results support the implementation advocated in the NICE guidelines by showing that adding financial incentives to current smoking cessation support for pregnant women is effective, does not impact current smoking cessation services in the UK and can save costs for the NHS in the longer term.

Future research should examine which format and level of incentive and at what frequency produces the most effective and cost-effective outcome, they write. An ongoing study is also examining ongoing incentives up to 12 months postpartum to prevent relapse.

Financial incentives for sustained smoking abstinence in pregnancy are among the most cost-effective public health interventions and represent an important opportunity to reduce health disparities in early life, researchers say in a linked editorial.

However, they point out that the partners of most pregnant women who smoke are also smokers and say that interventions "should also target smoking family members to create a smoke-free home for mother and child." Smoking cessation support for pregnant women “should continue beyond birth to improve disappointingly low long-term abstinence rates,” they add.

"The medical community now has good evidence of effective tools, such as financial incentives, to reduce the health burden associated with tobacco smoking during pregnancy. These tools should be used wherever possible to protect and improve the health of women, their children and others." Families,” they conclude.

Source:

BMJ

Reference:

Tappin, D., et al. (2022) Impact of financial voucher incentives provided within UK smoking cessation services on smoking cessation in pregnant women (CPIT III): pragmatic, multicentre, single-blind, phase 3 randomized controlled trial. The BMJ. doi.org/10.1136/bmj-2022-071522.

.