VOUCHER-BASED INCENTIVES TO TREAT PREGNANT SMOKERS

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。母亲吸烟是可预防的胎儿和婴儿死亡和发病率的主要原因。尽管做出了巨大的努力来减少吸烟，但大约30%的美国妇女在怀孕时吸烟，75%的妇女在怀孕期间继续吸烟，约33%的人在怀孕期间试图戒烟。已经为怀孕吸烟者制定了有效的戒烟干预措施，但戒烟率普遍较低(例如，20%)，复发仍然是一个问题。迫切需要更有效的干预措施，以促进戒烟并防止怀孕吸烟者复发。在拟议的项目中，我们将检查基于代金券的激励计划在提高戒烟率和减少怀孕吸烟者复发方面的有效性。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，以提高在第一次产前检查时仍在吸烟的女性的戒烟率。第二次试验将审查相同的主题，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。第三项试验将审查应急代金券在预防在第一次产前检查时已开始戒烟的妇女中复发的效果。总体而言，拟议的试验有可能为减少贫穷孕妇及其胎儿/婴儿的吸烟和相关不良影响提供重要的新的科学信息。

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.