Effect of Smartphone-Based Financial Incentives on Peripartum Smoking Among Pregnant Individuals

Kurti, Allison N.; Nighbor, Tyler D.; Tang, Katherine; Bolívar, Hypatia A.; Evemy, Carolyn; Skelly, Joan M.; Higgins, Stephen T.

doi:10.1001/jamanetworkopen.2022.11889

Cited by 21 publications

(15 citation statements)

References 5 publications

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“…Unlike other trials, acceptability of financial incentives to pregnant women and health professionals from recorded interviews24 was examined along with cost effectiveness 2728. Two contemporary US trials4041 showed similar cessation improvements when financial incentives were added to Best Practice defined by the Centres for Disease Control. The first also examined cost effectiveness 42.…”

Section: Discussionmentioning

confidence: 99%

Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial

Tappin

Sinclair

Kee

et al. 2022

BMJ

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Objective To examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services. Design Pragmatic, multicentre, single blinded, phase 3, randomised controlled trial (Cessation in Pregnancy Incentives Trial phase 3 (CPIT III)). Setting Seven UK stop smoking services provided in primary and secondary care facilities in Scotland, Northern Ireland, and England. Participants 944 pregnant women (age ≥16 years) who self-reported as being smokers (at least one cigarette in the past week) when asked at first maternity visit, less than 24 weeks’ gestation, and notified to the trial team by routine stop smoking services. Interventions Participants in the control group were offered the standard stop smoking services, which includes the offer of counselling by specially trained workers using withdrawal orientated therapy and the offer of free nicotine replacement therapy. The intervention was the offer of usual support from the stop smoking services and the addition of up to £400 ($440; €455) of LoveToShop financial voucher incentives for engaging with current stop smoking services or to stop smoking, or both, during pregnancy. Main outcome measures Self-reported smoking cessation in late pregnancy (between 34 and 38 weeks’ gestation) corroborated by saliva cotinine (and anabasine if using nicotine replacement products). Results were adjusted for age, smoking years, index of multiple deprivation, Fagerström score, before or after covid, and recruitment site. Secondary outcomes included point and continuous abstinence six months after expected date of delivery, engagement with stop smoking services, biochemically validated abstinence from smoking at four weeks after stop smoking date, birth weight of baby, cost effectiveness, generalisability documenting formats of stop smoking services, and acceptability to pregnant women and their carers. Results From 9 January 2018 to 4 April 2020, of 4032 women screened by stop smoking services, 944 people were randomly assigned to the intervention group (n=471) or the control group (n=470). Three people asked for their data to be removed. 126 (27%) of 471 participants stopped smoking from the intervention group and 58 (12%) of 470 from the control group (adjusted odds ratio 2.78 (1.94 to 3.97) P<0.001). Serious adverse events were miscarriages and other expected pregnancy events requiring hospital admission; all serious adverse events were unrelated to the intervention. Most people who stopped smoking from both groups relapsed after their baby was born. Conclusions The offer of up to £400 of financial voucher incentives to stop smoking during pregnancy as an addition to current UK stop smoking services is highly effective. This bolt-on intervention supports new guidance from the UK National Institute for Health and Care Excellence, which includes the addition of financial incentives to support pregnant women to stop smoking. Continuing incentives to 12 months after birth is being examined to prevent relapse. Trial registration ISRCTN Registry ISRCTN15236311 .

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Section: Discussionmentioning

confidence: 99%

Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial

Tappin

Sinclair

Kee

et al. 2022

BMJ

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show abstract

“…In 2019, a Cochrane review identified 33 randomized controlled trials (RCTs) investigating the effect of financial incentives [ 3 ]. Since then, several other RCTs have confirmed that incentives are an efficient, cheap, and safe method to improve quit rates [ 4 , 20 , 21 , 22 , 23 , 24 , 25 ]. Results from several studies indicate that offering small financial incentives for smoking abstinence are also efficient in disadvantaged persons [ 26 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Smoking Cessation Programs Are Less Effective in Smokers with Low Socioeconomic Status Even When Financial Incentives for Quitting Smoking Are Offered—A Community-Randomized Smoking Cessation Trial in Denmark

Pisinger

Toxværd

Rasmussen

2022

IJERPH

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Financial incentives offered to those who quit smoking have been found effective, also in persons with low socioeconomic status (SES), but no previous study has investigated who benefits most: smokers with low or high SES. In this community-randomized trial (“Richer without smoking”), three Danish municipalities were randomized to reward persons who were abstinent when attending the municipal smoking cessation program (FIMs) and three municipalities were randomized to spend the same amount on smoking cessation campaigns recruiting smokers to the smoking cessation program (CAMs). The municipalities each received approximately USD 16,000. An intention-to-treat approach was used in analyses. In regression analyses adjusted for individual- and municipal-level differences, we found that smokers with high SES living in FIMs had significantly higher proportion of validated long-term successful quitters (OR (95% CI): 2.59 (1.6–4.2)) than high-SES smokers living in CAM. Smokers with low SES, however, did not experience the same benefit of financial incentives as smokers with high SES. Neither the FIMs nor the CAMs succeeded in attracting more smokers with low SES during the intervention year 2018 than the year before. Our study showed that smokers with low SES did not experience the same benefit of financial incentives as smokers with high SES.

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“…Pilot trials found similar results among smokers with attention-deficit hyperactivity disorder (Dan et al, 2016), homeless adults (Carpenter et al, 2015), adolescents (Kong et al, 2017), and regular smokers (Alessi et al, 2017; Dallery et al, 2021). Using remote methods and enrolling pregnant women from 33 states ( n = 90), a digital CM program for peripartum smoking resulted in a four-fold increase in abstinence at 24 weeks compared to best practices (Kurti et al, 2022). This study also incorporated a transition from breath CO during the first week of treatment to a salivary cotinine procedure thereafter (cotinine is a metabolite of nicotine).…”

Section: Technology To Promote Access To High-fidelity CMmentioning

confidence: 99%

Digital Contingency Management in the Treatment of Substance Use Disorders

Dallery

DeFulio

Raiff

2023

Policy Insights from the Behavioral and Brain Sciences

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Contingency management (CM) provides incentives based on drug abstinence or other treatment goals; it is one of the most efficacious and cost-effective psychosocial interventions for substance use disorders. However, CM remains severely underused in clinical care. Digital methods to deliver CM could dramatically expand access. These methods include information and drug sensing technologies to obtain objective evidence of drug abstinence, authenticate the end-user's identity, and deliver incentives immediately. Digital CM has been applied successfully to cigarette smoking, alcohol misuse, and more recently illicit drug use. Policies should continue to evolve to promote the delivery of digital CM based on decades of research.

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Effect of Smartphone-Based Financial Incentives on Peripartum Smoking Among Pregnant Individuals

Cited by 21 publications

References 5 publications

Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial

Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial

Smoking Cessation Programs Are Less Effective in Smokers with Low Socioeconomic Status Even When Financial Incentives for Quitting Smoking Are Offered—A Community-Randomized Smoking Cessation Trial in Denmark

Digital Contingency Management in the Treatment of Substance Use Disorders

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