Give It Up For Baby: outcomes and factors influencing uptake of a pilot smoking cessation incentive scheme for pregnant women

Andrew Radley,Douglas Eadie,Susan Macaskill,David Tappin,Paul Ballard,Louise Donnelly

doi:10.1186/1471-2458-13-343

Abstract

BackgroundThe use of incentives to promote smoking cessation is a promising technique for increasing the effectiveness of interventions. This study evaluated the smoking cessation outcomes and factors associated with success for pregnant smokers who registered with a pilot incentivised smoking cessation scheme in a Scottish health board area (NHS Tayside).MethodsAll pregnant smokers who engaged with the scheme between March 2007 and December 2009 were included in the outcome evaluation which used routinely collected data. Data utilised included: the Scottish National Smoking Cessation Dataset; weekly and periodic carbon monoxide (CO) breath tests; status of smoking cessation quit attempts; and amount of incentive paid. Process evaluation incorporated in-depth interviews with a cross-sectional sample of service users, stratified according to level of engagement.ResultsQuit rates for those registering with Give It Up For Baby were 54% at 4 weeks, 32% at 12 weeks and 17% at 3 months post partum (all data validated by CO breath test). Among the population of women identified as smoking at first booking over a one year period, 20.1% engaged with Give It Up For Baby, with 7.8% of pregnant smokers quit at 4 weeks. Pregnant smokers from more affluent areas were more successful with their quit attempt. The process evaluation indicates financial incentives can encourage attendance at routine advisory sessions where they are seen to form part of a wider reward structure, but work less well with those on lowest incomes who demonstrate high reliance on the financial reward.ConclusionsUptake of Give It Up For Baby by the target population was higher than for all other health board areas offering specialist or equivalent cessation services in Scotland. Quit successes also compared favorably with other specialist interventions, adding to evidence of the benefits of incentives in this setting. The process evaluation helped to explain variations in retention and quit rates achieved by the scheme.This study describes a series of positive outcomes achieved through the use of incentives to promote smoking cessation amongst pregnant smokers.

Highlights

The use of incentives to promote smoking cessation is a promising technique for increasing the effectiveness of interventions
Smoking during pregnancy increases the risk of maternal complications, pre-term delivery and low birth weight
Intervention design All women who continued to smoke during their pregnancy in the three intervention areas across NHS Tayside were invited to register with the Give It Up For Baby (GIUFB) scheme at a local community pharmacy

Summary

Introduction

The use of incentives to promote smoking cessation is a promising technique for increasing the effectiveness of interventions. Smoking during pregnancy increases the risk of maternal complications, pre-term delivery and low birth weight. Low birth weight is associated with a variety of important adult health problems including coronary heart disease, type II diabetes and obesity [1]. Tobacco smoking during pregnancy is relatively common, especially in low to middle income populations but is strongly associated with poverty, low educational attainment, poor social support and mental health issues [2]. There is an emerging body of evidence that suggests financial incentives can be an effective mechanism to encourage smokers to quit [5]. Whilst reward-based programmes have been shown to help initiate and support quitting, it is recognised that to realise their full potential there is a need to develop an understanding of how incentives can be integrated with other forms of structured support in order to sustain the behaviour change [6]

Methods

Results

Discussion

Conclusion