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Financial Vouchers for Smoking Cessation in Pregnancy

The Cessation in Pregnancy Incentives Trial phase 3 (CPIT III) concludes that providing financial voucher incentives of £400 is highly effective for increasing smoking cessation rates during pregnancy when combined with other smoking services offered in the U.K. (including free nicotine-replacement therapy). “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,” the authors conclude. “Continuing incentives to 12 months after birth is being examined to prevent relapse.”

The pragmatic, single-blinded trial was conducted in Scotland, Northern Ireland, and England. Study participants were aged 16 years or older and at less than 24 weeks’ gestation at their first maternity visit. Patients reporting smoking 1 or more cigarettes in the past week were offered standard smoking services, and those randomized to the intervention group also received a financial voucher for engaging with current stop smoking services or to stop smoking, or both, during pregnancy.

Results for 941 participants showed cessation rates of 27% in the intervention group and 12% in the control group for a significant adjusted odds ratio of 2.78 (1.94–3.97, 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,” the investigators write. “Most people who stopped smoking from both groups relapsed after their baby was born.”

Editorial: “An important observation is that the partners of most pregnant women who smoke are also smokers (59% in [in this trial] and >70% in [a] French trial, for example),” editorialists write. “This problem needs to be addressed, as a smoking partner is an important barrier to remaining abstinent from smoking during pregnancy, the risk of relapse after birth is increased, and environmental tobacco smoke in the house is harmful to children. Smoking cessation interventions should also be targeted at family members who smoke, to create a smoke-free home for mother and child. Furthermore, smoking cessation support for pregnant women should continue beyond childbirth to improve the disappointingly low long term abstinence rates. This support could include additional financial incentives during the postpartum period and might be specifically targeted at women on low incomes.”

Source: BMJ