Randomized clinical trial examining the efficacy of adding financial incentives to best practices for smoking cessation among pregnant and newly postpartum women
Mené aux Etats-Unis entre 2014 et 2020 sur 249 femmes enceintes ou ayant récemment accouché, cet essai randomisé évalue l'intérêt d'ajouter une incitation financière aux conseils de bonnes pratiques pour augmenter l'abstinence tabagique et réduire les risques gestationnels
We report results from a randomized clinical trial examining financial incentives for smoking cessation among 249 pregnant and newly postpartum women. Participants included 169 women assigned to best practices (BP) or BP plus financial incentives (BP + FI) for smoking cessation available through 12-weeks postpartum. A third condition included 80 never-smokers (NS) sociodemographically-matched to women who smoked. Trial setting was Burlington, Vermont, USA, January 2014 through January 2020. Outcomes included 7-day point-prevalence abstinence antepartum and postpartum, and birth and other infant outcomes during 1st year of life. Reliability and external validity of results were assessed using pooled results from the current and four prior controlled trials coupled with data on maternal-smoking status and birth outcomes for all 2019 singleton live births in Vermont. Compared to BP, BP + FI significantly increased abstinence early- (AOR = 9.97; 95%CI, 3.32–29.93) and late-pregnancy (primary outcome, AOR = 5.61; 95%CI, 2.37–13.28) and through 12-weeks postpartum (AOR = 2.46; CI,1.05–5.75) although not 24- (AOR = 1.31; CI,0.54–3.17) or 48-weeks postpartum (AOR = 1.33; CI,0.55–3.25). There was a significant effect of trial condition on small-for-gestational-age (SGA) deliveries (χ2 [2] = 9.01, P = .01), with percent SGA deliveries (±SEM) greatest in BP, intermediate in BP + FI, and lowest in NS (17.65 ± 4.13, 10.81 ± 3.61, and 2.53 ± 1.77, respectively). Reliability analyses supported the efficacy of financial incentives for increasing abstinence antepartum and postpartum and decreasing SGA deliveries; external-validity analyses supported relationships between antepartum cessation and SGA risk. Adding financial incentives to Best Practice increases smoking cessation antepartum and postpartum women and improves other maternal-infant outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02210832.