Digital rewards program targets smoking cessation during pregnancy

A new award from the National Institute on Drug Abuse will advance a smartphone-based treatment aimed at helping pregnant individuals quit smoking.

The multi-phase federal award was granted to University of Vermont Distinguished Professor Stephen T. Higgins, Ph.D., professor of psychiatry and director of the Vermont Center on Behavior and Health (VCBH) at the Robert Larner, M.D. College of Medicine. The funds will support further testing of a digital financial-incentives intervention that provides rewards for verified smoking abstinence. Should trial outcomes support the effectiveness of the intervention, the treatment can be designated an FDA-approved digital intervention. 

Cigarette smoking remains the leading preventable cause of poor pregnancy outcomes in the United States, contributing to serious health risks for both mothers and infants. The burden is particularly high in rural communities, where pregnant individuals are more likely to smoke and often have limited access to evidence-based cessation programs.

"Widespread closures of rural hospital and a lack of on-site services means there are fewer clinic-based perinatal smoking cessation programs in the U.S.," said Dr. Higgins, who pioneered this financial-incentives approach. "By transitioning to a remote digital therapeutic, we can bypass those limitations and deliver life-saving support directly to families who need it most."

Using a smartphone application developed by DynamiCare Health, participants submit videos of themselves completing salivary cotinine tests, which measure nicotine exposure. The system verifies smoking status and delivers money directly to a secure debit card. The card is managed to prohibit spending on non-essential or restricted items such as alcohol, cannabis, and firearms.

Participant enrollment is expected to begin in summer 2026, using national remote recruitment strategies refined through the team's previous randomized clinical trials.

Higgins is one of the most influential and important leaders in the substance use disorder field. In the 1990s, Higgins and other researchers demonstrated that providing small financial rewards (vouchers redeemable for retail items) can increase healthy choices in treatment-recalcitrant populations. His work in contingency management revolutionized treatment approaches for patients with substance use disorders, providing one of the few efficacious clinical interventions to change human behavior. Previous studies by Higgins and colleagues have shown that incentive-based smoking cessation treatment improved cessation rates among pregnant people. Additional Larner collaborators on this study include Ira M. Bernstein, M.D., Michael J. DeSarno, M.S., and Sarah H. Heil, Ph.D., in addition to Donald S. Shepard, Ph.D. from Brandeis University.