Financial Incentives for Smoking Cessation Among Depression-Prone Pregnant and Newly Postpartum Women: Effects on Smoking Abstinence and Depression Ratings

Lopez, Alexa A.; Skelly, Joan M.; Higgins, Stephen T.

doi:10.1093/ntr/ntu193

Cited by 29 publications

(28 citation statements)

References 30 publications

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“…Moreover, keeping two of the treatment conditions in this trial (usual incentive schedule and the non-contingent voucher control condition) largely identical with prior trials has allowed for collapsing data across trials for greater power to examine treatment effects on other outcomes. That strategy was used in studies demonstrating improvements in birth outcomes [32] and breastfeeding duration [33] with the incentives intervention and in the studies discussed below examining depressive symptoms and impulsivity [34, 35]. Worth mentioning is that trends in the current trial favoring improved birth outcomes among infants born to mothers in the usual incentives condition are consistent with those earlier findings, although not so with breastfeeding.…”

Section: Resultssupporting

confidence: 53%

Some Recent Developments on Financial Incentives for Smoking Cessation Among Pregnant and Newly Postpartum Women

Higgins

Solomon

2016

Curr Addict Rep

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Smoking during pregnancy is a leading preventable cause of poor pregnancy outcomes and immediate and longer-term adverse health outcomes among exposed offspring. Developing more effective smoking-cessation interventions for pregnant women has been a public-health priority for more than thirty years. We review developments over the past three years (2012–15) on the use of financial incentives to promote smoking cessation among pregnant women. We searched the literature for reports on primary and secondary analyses and reviews of controlled trials on this topic published in peer-reviewed journals using the search engine PubMed, reviewed bibliographies of published articles, and consulted expert colleagues. The search revealed several important developments, with the following three being especially noteworthy. First, the review identified four new randomized controlled trials, three of which further supported the efficacy of this treatment approach. One of the three trials supporting efficacy also included the first econometric analysis of this treatment approach showing financial incentives with pregnant smokers to be highly cost-effective. Second, two Cochrane reviews were published during this 3-year period covering the more recent and earlier efficacy trials. Meta-analyses in both reviews supported the efficacy of the approach. Lastly, the first effectiveness trial was reported demonstrating that financial incentives increased abstinence rates above control levels when implemented by obstetrical clinic staff in a large urban hospital working with community tobacco interventionists. Overall, there is a growing and compelling body of evidence supporting the efficacy and cost-effectiveness of financial incentives for smoking cessation among pregnant women.

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Section: Resultssupporting

confidence: 53%

Some Recent Developments on Financial Incentives for Smoking Cessation Among Pregnant and Newly Postpartum Women

Higgins

Solomon

2016

Curr Addict Rep

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“…21–23 An incentive-based cessation trial resulted in increased cessation among pregnant women with diagnosed depression, and the intervention reduced the severity of postpartum depression symptoms. 22 Furthermore, smokers with mental health conditions are just as motivated to quit as those not reporting mental health conditions. 24,25 Patients and health care providers should be aware that tobacco cessation can contribute to improved mental health and improved pregnancy health.…”

Section: Discussionmentioning

confidence: 99%

Smoking Before and During Pregnancy Among Women Reporting Depression or Anxiety

Tong

Farr

Bombard

et al. 2016

Obstetrics &Amp; Gynecology

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OBJECTIVE To describe prepregnancy smoking, pre-natal smoking, and prenatal cessation among women reporting and not reporting depression or anxiety. METHODS We analyzed cross-sectional data from the 2009–2011 Pregnancy Risk Assessment Monitoring System, a population-based survey of women with live births (N=34,633). Smoking status was defined as self-reported prepregnancy smoking (during the 3 months before pregnancy), prenatal smoking (during the last 3 months of pregnancy), and prenatal cessation (no smoking by the last 3 months among prepregnancy smokers). Depression and anxiety status was self-reported of having either condition or both during the 3 months before pregnancy. We compared smoking prevalence by self-reported depression and anxiety status using χ2 tests and adjusted prevalence ratios. RESULTS Overall, 16.9% of women in our sample reported depression, anxiety, or both during the 3 months before pregnancy. Compared with those who did not report, women who reported depression or anxiety had significantly higher prepregnancy (46.7% compared with 22.5%, P<.01) and prenatal smoking (27.5% compared with 10.5%, P<.01). A lower proportion of prepregnancy smokers who reported depression or anxiety quit smoking by the last 3 months of pregnancy than those who did not report (41.4% compared with 53.8%, P<.01). In adjusted analyses, women reporting depression or anxiety were 1.5 and 1.7 times more likely to smoke prepregnancy and prenatally, respectively, and less likely to quit smoking (adjusted prevalence ratio 0.86, 95% confidence interval 0.80–0.92). CONCLUSION Women who reported depression, anxiety, or both were more likely to smoke before and during pregnancy and less likely to quit smoking during the prenatal period. Screening recommendations for perinatal depression and anxiety provide an opportunity to identify a subpopulation of women who may have a higher prevalence of smoking and to provide effective tobacco cessation interventions and mental health care.

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“…6,7 Others are based on financial incentives [8][9][10] and nicotine replacement therapy. [11][12][13] While some of these interventions have improved cessation during pregnancy, they lack effectiveness for the prevention of postpartum relapse.…”

Section: Introductionmentioning

confidence: 99%

Progesterone and Postpartum Smoking Relapse: A Pilot Double-Blind Placebo-Controlled Randomized Trial

Allen

Lunos

et al. 2016

NICTOB

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Introduction: Pregnancy is a strong motivator to quit smoking, yet postpartum relapse rates are high. Growing evidence suggests a role of sex hormones in drug abuse behavior and given the precipitous drop in sex hormones at delivery, they may play a role in postpartum relapse. This pilot study evaluates the feasibility and potential role of exogenous progesterone in postpartum smoking relapse. Methods: This 12-week double-blind placebo-controlled randomized pilot trial randomized 46 abstinent postpartum women to active progesterone (PRO; 200 mg twice a day) versus placebo (PBO) for 4 weeks. Participants were followed for relapse for 12 weeks. Main study outcomes include abstinence (point prevalence), feasibility (compliance per number of clinic visits attended, pill counts and Electronic Data Capture [EDC] completed) and self-reported acceptability. Safety was also measured by depressive symptom scores, adverse events, and breastfeeding. Results: Overall retention rate was 87% at week 12. At week 4, abstinence rates were 75% in the PRO group and 68.2% in the PBO group (p = .75). Medication adherence was 68% and clinic visit attendance was 80%, with no differences by randomization. Depressive symptom scores, adverse events, and breastfeeding did not vary by randomization. Conclusions: Although the study was not powered to evaluate abstinence rates, we did observe a higher prevalence of abstinence at week 4 in the PRO group. Further, exogenous progesterone was well tolerated and did not adversely affect depressive symptoms or breastfeeding. Thus, the results of this pilot study indicate further investigation into progesterone as a postpartum relapse prevention strategy is warranted. Implications: This innovative pilot trial determined the feasibility of delivering exogenous progesterone as a potential prevention of postpartum smoking relapse. We observed high retention and moderate adherence rates, as well as high acceptability among participants. Further, though not statistically significant, more women in the treatment group remained abstinent from smoking during follow-up. This project adds to the growing body of literature on the role of sex hormones in smoking relapse and also provides support for a fully powered clinical trial.

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Financial Incentives for Smoking Cessation Among Depression-Prone Pregnant and Newly Postpartum Women: Effects on Smoking Abstinence and Depression Ratings

Cited by 29 publications

References 30 publications

Some Recent Developments on Financial Incentives for Smoking Cessation Among Pregnant and Newly Postpartum Women

Some Recent Developments on Financial Incentives for Smoking Cessation Among Pregnant and Newly Postpartum Women

Smoking Before and During Pregnancy Among Women Reporting Depression or Anxiety

Progesterone and Postpartum Smoking Relapse: A Pilot Double-Blind Placebo-Controlled Randomized Trial

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