Voucher Based Incentives to Treat Pregnant Smokers
Condition: Efficacy of Financial Incentives
Study type: Interventional

Summary: 
      The major goal of this project is to examine the efficacy of a voucher-based incentive
      program for promoting smoking cessation (Study 1) and preventing relapse (Study 2) during
      pregnancy and postpartum. Identifying efficacious interventions to increase cessation rates
      and decrease relapse among those who are able to quit is important to improving U.S. public
      health.
    

Detailed description: 
      Maternal cigarette smoking is the leading preventable cause of poor pregnancy outcomes and
      pediatric morbidity and mortality in the U.S. Efficacious interventions have been developed
      for smoking cessation during pregnancy, but cessation rates are low, typically under 20%.
      Efficacious interventions to prevent postpartum relapse remain to be developed. This
      application seeks support for a Stage II behavioral therapies development project to continue
      examining interventions to increase smoking cessation above the low levels noted above and to
      decrease postpartum relapse.

      With regard to cessation, we conducted studies during the prior funding period showing that
      voucher-based incentives delivered contingent on biochemically-verified abstinence promote
      smoking cessation in approximately 40% of women who were still smoking at their 1st prenatal
      visit compared to only 9% in a control condition. Comparable studies on decreasing postpartum
      relapse among women who were smokers upon learning of their pregnancy but quit by their 1st
      prenatal visit (spontaneous quitters) supported the efficacy of abstinence-contingent
      vouchers for preventing antepartum but not postpartum relapse. We also completed secondary
      studies on appropriate cutpoints for biochemically verifying smoking status in pregnant
      women, characterizing the quantitative relationship between smoking exposure and fetal
      growth, the time-course of depressive symptoms during pregnancy in smokers and abstainers,
      and the incidence and severity of nicotine withdrawal.

      While the treatment effect on smoking cessation during pregnancy noted above is at least
      two-fold greater than usual outcomes, the majority of women, especially heavier smokers (> 10
      cigs/day), failed to quit. In Study 1 of this application we propose to experimentally
      examine whether a revised voucher program designed to increase initial abstinence and
      encourage additional quit attempts among those who initially fail can promote cessation at
      the end-of-pregnancy assessment in the majority of women treated (> 60%). Considering that
      nobody has succeeded in decreasing postpartum relapse among spontaneous quitters, we are not
      surprised that our first effort was unsuccessful. In Study 2 of this application we propose
      to experimentally test whether a revised voucher-based incentive program designed to more
      effectively reinforce sustained abstinence will decrease postpartum relapse. We are also
      proposing to continue secondary studies on biochemical verification of smoking status, fetal
      growth, and predictors of postpartum relapse.

      Overall, the proposed studies have the potential to contribute important new information on
      effective treatments for one of our nation's most daunting drug abuse problems.
    

Intervention name(s): Voucher-based incentives
Intervention type(s): Behavioral
Other intervention name(s): Contingency Management
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: pregnancy; cigarette smoking; incentives; smoking cessation; birth outcomes