Abstract
BackgroundFinancial incentives appear to be effective in promoting smoking cessation in pregnancy. The mechanisms by which they might operate however, are poorly understood. The present study examines how financial incentives for smoking cessation during pregnancy may work, by exploring pregnant women's experiences of trying to stop smoking, within and outside of a financial incentives scheme.MethodsThirty-six (n = 36) UK-based pregnant smokers (n = 36), offered standard NHS Stop-Smoking Services, of whom twenty (n = 20) were enrolled in a financial incentives scheme for smoking cessation (n = 20) and sixteen (n = 16) were not, were interviewed about (i) their motivation to stop smoking, and (ii) the factors they perceived as influencing their quitting efforts. Framework Analysis was used to analyse the data.ResultsWomen in the two groups reported similar reasons for wanting to stop smoking during pregnancy. However, they described dissimilar experiences of the Stop-Smoking Services, which they perceived to have differentially influenced their quit attempts. Women who were incentivised reported using the services more than women who were not incentivised. In addition, they described the motivating experience of being monitored and receiving feedback on their progress. Non-incentivised women reported problems receiving the appropriate Nicotine Replacement Therapy, which they described as having a detrimental effect on their quitting efforts.ConclusionWomen participating in a financial incentives scheme to stop smoking reported greater engagement with the Stop-Smoking Services, from which they described receiving more help in quitting than women who were not part of the scheme. These results highlight the complexity of financial incentives schemes and the intricacies surrounding the ways in which they operate to affect smoking cessation. These might involve influencing individuals' motivation and self-regulation, changing engagement with and provision of support services, or a combination of these.
Highlights
Financial incentives appear to be effective in promoting smoking cessation in pregnancy
Participants were recruited through an opportunistic sampling frame involving a population of 115 pregnant smokers living in the greater Birmingham area (Figure 1) who were referred by their midwives to the NHS Stop-Smoking Services during the period September 2009 to May 2010 and: i. were enrolled in a pilot scheme of incentivising smoking cessation run by the Birmingham East & North Primary Care Trust (BEN PCT)
The themes emerging in the accounts given by the two groups of women, with regards to i) their motivation for wanting to quit smoking, and ii) the factors they perceived as facilitating and inhibiting their quit attempts, are presented below
Summary
Financial incentives appear to be effective in promoting smoking cessation in pregnancy. It causes up to 4,000 deaths per year in the UK from miscarriages and stillbirths, and leads to increases in preterm births, low birth-weight babies [3,4], sudden infant death, asthma and attention deficit hyperactivity disorder [4,5]. Despite these adverse consequences, many women fail to quit while pregnant, with at least 17% of mothers in the UK smoking throughout their pregnancies in 2005 [6]. The mechanisms by which financial incentives operate to influence behaviour, including smoking cessation during pregnancy, are, poorly understood
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