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27/02/2015
The study was led by researchers at the University of Cambridge and King's College London and its findings have been published in the journal Addiction. It revealed that while there were some women who "gamed" the system – that is, receiving incentives while continuing to smoke – the number was small.
Currently, it has been said that one in eight women (12%) in England smoke during pregnancy. This varies from one in 200 (0.5%) in areas of low deprivation, to one in four (27%) in areas of high deprivation.
A recent review did find financial incentive schemes to be the single most effective intervention for encouraging women to stop smoking during pregnancy, but this was based on a few small trials in the USA and only measured smoking cessation after one week, the research said.
Therefore, in order to identify the potential effectiveness of financial incentives and inform their use in clinical practice, as well as to see to what extent it led women to 'game' the system, researchers carried out a new study. It involved women attending antenatal clinics at a hospital in Chesterfield, Derbyshire, an area of high deprivation. In total, 239 pregnant women – or two out of five women who attended the clinic – enrolled into the financial incentives scheme.
During each of their visits to the clinic, the women were asked if they had smoked since the last visit and were given a carbon monoxide breath test. The test would show a positive result if the woman had smoked within the past few hours. If they had not smoked, they were given a shopping voucher; the first voucher was worth £8 and the value increased by £1 for each visit up, providing a potential maximum of £752 in vouchers.
Meanwhile, testing positive for smoking resulted in the incentive being withheld at that visit and the value being reset to £8 for the next visit. If, following two consecutive test results which indicated no smoking, the incentive was re-set to the highest point attained prior to the lapse.
In addition to the above, researchers also took saliva samples from the mothers. These were assessed at time of delivery and then six months later, to see if the women had quit smoking, complemented with urinary and saliva tests at enrolment, 28 and 36 weeks into pregnancy and then two days and six months after the birth of their child.
Of the women who had enrolled into the scheme, 143 received at least one voucher, suggesting that they had attempted to quit. One in five women (48 women) had managed to quit by the time of delivery, with 25 women (10%) still not smoking six months after the birth of their child.
This compared to the previous year, when only a very small number of women (less than 1%) were recorded as having stopped smoking.
In each of the cases, women from areas of highest deprivation were the least likely to succeed in quitting.
As for those who 'gamed' the system, urinary or salivary tests suggested that ten women (4%) had smoked cigarettes whilst claiming vouchers.
Professor Theresa Marteau, from the Behaviour and Health Research Unit at the University of Cambridge, explained: "We all know of the dangers of smoking, particularly during pregnancy, but quitting can be extremely difficult.
"Offering financial incentives clearly works for some women – with very few 'gaming' the system and a significant number stopping smoking at least for the duration of their pregnancy."
Louise Silverton, Director for Midwifery at the royal College of Midwives (RCM), added: "This is as another piece of interesting and welcome research showing that incentivising women to stop smoking when pregnant does increase the numbers who are able to do so.
"Although financial incentivisation may be one way forward, it will be expensive and alternative ways of stopping smoking in pregnancy also need attention."
In total, £37,490 was spent on the financial incentive, which the researchers believe is likely to prove an "acceptable ratio" of cost to benefit.
Ms Silverton continued: "Ideally those who plan their pregnancy should be supported to stop smoking before conception. Greater antenatal advice and support to encourage women to quit smoking in pregnancy would also be beneficial.
"Overall what is needed is a greater investment in prevention and in the health, educational and social care staff needed to promote the health and wellbeing of individuals."
The scheme was funded by NHS Derbyshire County Primary Care Trust and Derbyshire County Council, with funding for the evaluation coming from the Wellcome Trust.
(JP)
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Shopping Vouchers 'Can Help Pregnant Women Quit Smoking'
New research has claimed that financial incentives, such as shopping vouchers, could help one in five women quit smoking during pregnancy.The study was led by researchers at the University of Cambridge and King's College London and its findings have been published in the journal Addiction. It revealed that while there were some women who "gamed" the system – that is, receiving incentives while continuing to smoke – the number was small.
Currently, it has been said that one in eight women (12%) in England smoke during pregnancy. This varies from one in 200 (0.5%) in areas of low deprivation, to one in four (27%) in areas of high deprivation.
A recent review did find financial incentive schemes to be the single most effective intervention for encouraging women to stop smoking during pregnancy, but this was based on a few small trials in the USA and only measured smoking cessation after one week, the research said.
Therefore, in order to identify the potential effectiveness of financial incentives and inform their use in clinical practice, as well as to see to what extent it led women to 'game' the system, researchers carried out a new study. It involved women attending antenatal clinics at a hospital in Chesterfield, Derbyshire, an area of high deprivation. In total, 239 pregnant women – or two out of five women who attended the clinic – enrolled into the financial incentives scheme.
During each of their visits to the clinic, the women were asked if they had smoked since the last visit and were given a carbon monoxide breath test. The test would show a positive result if the woman had smoked within the past few hours. If they had not smoked, they were given a shopping voucher; the first voucher was worth £8 and the value increased by £1 for each visit up, providing a potential maximum of £752 in vouchers.
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Meanwhile, testing positive for smoking resulted in the incentive being withheld at that visit and the value being reset to £8 for the next visit. If, following two consecutive test results which indicated no smoking, the incentive was re-set to the highest point attained prior to the lapse.
In addition to the above, researchers also took saliva samples from the mothers. These were assessed at time of delivery and then six months later, to see if the women had quit smoking, complemented with urinary and saliva tests at enrolment, 28 and 36 weeks into pregnancy and then two days and six months after the birth of their child.
Of the women who had enrolled into the scheme, 143 received at least one voucher, suggesting that they had attempted to quit. One in five women (48 women) had managed to quit by the time of delivery, with 25 women (10%) still not smoking six months after the birth of their child.
This compared to the previous year, when only a very small number of women (less than 1%) were recorded as having stopped smoking.
In each of the cases, women from areas of highest deprivation were the least likely to succeed in quitting.
As for those who 'gamed' the system, urinary or salivary tests suggested that ten women (4%) had smoked cigarettes whilst claiming vouchers.
Professor Theresa Marteau, from the Behaviour and Health Research Unit at the University of Cambridge, explained: "We all know of the dangers of smoking, particularly during pregnancy, but quitting can be extremely difficult.
"Offering financial incentives clearly works for some women – with very few 'gaming' the system and a significant number stopping smoking at least for the duration of their pregnancy."
Louise Silverton, Director for Midwifery at the royal College of Midwives (RCM), added: "This is as another piece of interesting and welcome research showing that incentivising women to stop smoking when pregnant does increase the numbers who are able to do so.
"Although financial incentivisation may be one way forward, it will be expensive and alternative ways of stopping smoking in pregnancy also need attention."
In total, £37,490 was spent on the financial incentive, which the researchers believe is likely to prove an "acceptable ratio" of cost to benefit.
Ms Silverton continued: "Ideally those who plan their pregnancy should be supported to stop smoking before conception. Greater antenatal advice and support to encourage women to quit smoking in pregnancy would also be beneficial.
"Overall what is needed is a greater investment in prevention and in the health, educational and social care staff needed to promote the health and wellbeing of individuals."
The scheme was funded by NHS Derbyshire County Primary Care Trust and Derbyshire County Council, with funding for the evaluation coming from the Wellcome Trust.
(JP)
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