VOUCHER-BASED INCENTIVES TO TREAT PREGNANT SMOKERS

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。母亲吸烟是可预防的胎儿和婴儿死亡和发病的主要原因。尽管为减少吸烟做出了巨大努力，但大约30%的美国妇女在怀孕时吸烟，75%的人在怀孕期间继续吸烟，大约33%的人在怀孕期间试图戒烟。已经为怀孕吸烟者开发了有效的戒烟干预措施，但戒烟率通常很低（例如，20%），复发仍然是一个问题。迫切需要采取更有效的干预措施，促进怀孕吸烟者戒烟并防止其复吸。在拟议的项目中，我们将研究基于代金券的激励计划对提高戒烟率和减少怀孕吸烟者复吸的有效性。为此，提出了三项随机试验。在第一个试验中，我们将检查根据最近戒烟的客观证据提供的代金券的有效性，以促进在首次产前检查时仍在吸烟的妇女的戒烟率。第二次试验将研究相同的主题，但将使用试验1中获得的信息来修改代金券计划以改善结果。第三项试验将检查应急券的有效性，以防止在第一次产前检查时已经开始戒烟尝试的妇女复发。 总体而言，拟议的试验有可能为减少贫困孕妇及其胎儿/婴儿的吸烟和相关不良影响提供重要的新科学信息。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Maternal cigarette smoking is a leading cause of preventable fetal and infant mortality and morbidity. Despite tremendous efforts to reduce smoking, approximately 30% of U.S. women are cigarette smokers at the time that they become pregnant, 75% of them continue smoking through the pregnancy, and about 33% of those who attempt to quit relapse during the pregnancy. Efficacious cessation interventions have been developed for pregnant smokers, but quit rates are generally low (e.g., 20%), and relapse remains a problem. More effective interventions to promote smoking cessation and prevent relapse in pregnant smokers are sorely needed. In the proposed project we will examine the efficacy of a voucher-based incentive program for increasing quit rates and decreasing relapse among pregnant smokers. Towards that end, three randomized trials are proposed. In the first trial, we will examine the efficacy of vouchers delivered contingent on objective evidence of recent smoking abstinence to promote quit rates among women who are still smoking at their first prenatal visit. The second trial will examine the same topic, but will use the information obtained in Trial 1 to modify the voucher program to improve outcomes. The third trial will examine the efficacy of contingent vouchers to prevent relapse among women who have already initiated a quit attempt at the time of their first prenatal visit. Overall, the proposed trials have the potential to contribute important new scientific information on decreasing smoking and related adverse effects among poor pregnant women and their fetuses/infants.