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妊娠结局不良的主要可预防原因。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不良健康后果。 怀孕期间吸烟与经济劣势密切相关，是健康差距的实质性因素。 有效的干预措施是可用的，但停止率很低（<20%），出生结果的改善往往不大或没有。 目前的治疗通常需要相对简短，低成本的干预措施（如怀孕特定的戒烟热线）。 人们普遍认为，迫切需要采取更有效的干预措施。 我们已经开发出一种新的行为经济干预，其中妇女获得财政奖励，视戒烟情况而定。 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是低强度方法或药物的几倍。 干预措施似乎也改善了分娩结果，增加了母乳喂养时间。 虽然前景很好，但至少在三个领域需要进一步研究。 (1)关于分娩结局和母乳喂养的证据来自于综合试验数据的研究，而不是单一的前瞻性试验，（2）尚未调查干预是否会产生其他产后健康改善，（3）尚未检查这种方法的总体成本效益。 为了研究这些悬而未决的问题，我们提出了一项随机对照的临床试验，比较目前最好的怀孕期间戒烟的做法与产后一年的有效性和成本效益。 最佳做法加上230怀孕，医疗补助受助人的经济激励。 我们还将包括第三个条件，即115名怀孕的非吸烟者与吸烟者相匹配 对社会人口和健康状况进行评估，比较治疗减轻吸烟负担的程度，并估计在不超过成本效益的情况下，进一步改善这种激励措施可能会取得多大的成就。 我们假设，最佳实践加上财政激励措施将比单独的最佳实践更有效，激励措施干预将具有成本效益，虽然增加激励措施比单独的最佳实践减少了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。 总的来说，这项拟议的研究有可能大大提高孕妇对成本效益戒烟的认识。 重要的是，由于怀孕期间吸烟与经济劣势之间存在密切联系，拟议的研究也有可能为减少健康差距的严重挑战提供新的知识。

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.