Financial reward stubs out smoking habit

By Piriya Mahendra

Rewarding drug-dependent pregnant women with money each time they cut down on or stop smoking is an effective way to reduce smoking levels in this population, say researchers.

Nearly half (48%) of pregnant methadone-maintained women who received monetary incentives for target reductions in cigarette smoking (defined as contingent management) cut their smoking levels by 75% after 10‑11 weeks.

Moreover, one-third (31%) of women had completely abstained from smoking by week 12 of the study.

By contrast, none of the women who received incentives independently of their smoking levels (noncontingent management) met either the 75% smoking-reduction or abstinence targets, while only 2% of women who received information about smoking risk during pregnancy but no incentives met just the former target.

Although women who received monetary reward for curbing their smoking habit had fewer preterm births and fewer babies with low birthweight than the other two groups of women, these differences were not statistically significant.

This could be due to the fact that the reductions in smoking started too late in the pregnancy (mid-second trimester) to have an effect on neonatal outcomes, suggest Michelle Tuten (Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA) and team. Alternatively, greater reductions in smoking may be needed to improve birth outcomes.

The study, published in Addiction, included 103 pregnant smokers who were prescribed methadone maintenance for heroin dependence. Of these, 42 were randomly assigned to receive contingent behavioral incentives, 28 received noncontingent behavioral incentives, and 32 received treatment as usual.

Smoking reduction was measured using carbon monoxide breath samples three times per week.

"The study's findings indicate that the contingency management procedure is effective for shaping smoking reduction and cessation in drug-dependent pregnant women," write the authors.

"The use of effective contingency management procedures with pregnant drug-dependent women may have particular importance, given the potential for improved outcomes not only for the mother, but the infant as well."

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