Financial Incentives for Smoking Cessation Among Disadvantaged Pregnant Women

描述(由申请人提供)：在美国，怀孕期间吸烟是导致不良妊娠结局的主要可预防原因。大多数怀孕吸烟者在怀孕期间继续吸烟，对婴儿造成严重的直接和长期的不利健康后果。孕期吸烟与经济上的不利因素高度相关，也是造成健康差距的重要因素。有有效的干预措施可用，但戒断率很低(20%)，分娩结果的改善通常不大或没有改善。目前的治疗通常需要相对短暂、低成本的干预(例如，针对怀孕的戒烟路线)。人们普遍认为，迫切需要更有效的干预措施。我们已经开发了一种新的行为经济干预措施，其中女性根据戒烟获得经济奖励。在一项对孕期吸烟治疗的荟萃分析中，经济激励措施的效果比低强度方法或药物的效果大几倍。这项干预似乎还可以改善分娩结果，延长母乳喂养持续时间。尽管前景看好，但至少在三个领域还需要进一步研究。(1)关于出生结局和母乳喂养的证据来自于合并了跨试验数据的研究，而不是单一的前瞻性试验，(2)尚未调查干预是否会在产后带来其他健康改善，以及(3)尚未检查这种方法的总体成本效益。为了检验这些悬而未决的问题，我们提议进行一项随机对照临床试验，比较目前妊娠期戒烟最佳做法与传统戒烟方法在产后一年内的疗效和成本效益。 在230名怀孕的医疗补助接受者中提供最佳实践和经济激励。我们还将包括与吸烟者匹配的115名怀孕的非吸烟者的第三种情况 对社会人口和健康状况进行评估，以比较治疗在多大程度上减轻吸烟负担，并估计在不超出成本效益的情况下，通过进一步改进这一激励措施可以取得多大成效。我们假设，最佳做法加上财政激励措施将比单独实施最佳做法更有效，激励措施干预措施将具有成本效益，虽然增加激励措施将比单独使用最佳做法减少更大比例的吸烟健康和经济负担，但在保持成本效益的同时可以做更多的事情。总体而言，这项拟议的研究有可能极大地提高对孕妇戒烟成本效益的了解。重要的是，由于孕期吸烟与经济劣势之间有很强的关联性，这项拟议的研究还有可能为减少健康差距带来的严重挑战贡献新的知识。

DESCRIPTION (provided by applicant): Smoking during pregnancy is the leading preventable cause of poor pregnancy outcomes in the U.S. Most pregnant smokers continue smoking through pregnancy producing serious immediate and longer-term adverse health consequences for the infant. Smoking during pregnancy is highly associated with economic disadvantage and a substantive contributor to health disparities. Efficacious interventions are available but cessation rates are low (<20 percent) and improvements in birth outcomes often modest or absent. Current treatments usually entail relatively brief, low-cost interventions (e.g. pregnancy-specific quit lines). There is broad consensus that more effective interventions are sorely needed. We have developed a novel behavioral-economic intervention in which women earn financial incentives contingent on smoking abstinence. In a meta-analysis of treatments for smoking during pregnancy, effect sizes achieved with financial incentives were several-fold larger than those achieved with lower-intensity approaches or medications. The intervention also appears to improve birth outcomes and increase breastfeeding duration. While highly promising, further research is needed in at least three areas. (1) The evidence on birth outcomes and breastfeeding is from studies that combined data across trials rather than a single prospective trial, (2) whether the intervention produces other postpartum improvements in health has not been investigated, and (3) the overall cost-effectiveness of this approach has not been examined. To examine these unanswered questions, we are proposing a randomized, controlled clinical trial comparing the efficacy and cost effectiveness throuh one-year postpartum of current best practices for smoking-cessation during pregnancy vs. best practices plus financial incentives among 230 pregnant, Medicaid recipients. We will also include a third condition of 115 pregnant non-smokers matched to the smokers on socio-demographic and health conditions to compare the extent to which the treatments reduce the burden of smoking and to estimate how much more might be accomplished by further improvements in this incentives intervention without exceeding cost-effectiveness. We hypothesize that best practices plus financial incentives will be more effective than best practices alone, that the incentives intervention will be cost effective, and that while adding the incentives reduces a greater proportion of the health and economic burden of smoking than best practices alone, more can be done while remaining cost effective. Overall, the proposed study has the potential to substantially advance knowledge on cost-effective smoking cessation for pregnant women. Importantly, because of the strong association between smoking during pregnancy and economic disadvantage, the proposed study also has the potential to contribute new knowledge relevant to reducing the serious challenges of health disparities.