Effect of 3 months and 12 months of financial incentives on 12-month postpartum smoking cessation maintenance: a randomised controlled trial

Lewis, Sarah; Mckell, Jennifer; Coleman, Tim; Cooper, Sue; Orton, Sophie; Bauld, Linda; Usher, John

Abstract

Background and aims
Offering financial incentives is effective for smoking cessation during pregnancy. We tested the effectiveness of financial incentives for maintaining postpartum cessation, comparing 12-month and 3-month incentives with each other and with usual care (UC).

Design, setting and participants
This study was a pragmatic, multi-centre, three-arm randomized controlled trial involving four English, National Health Service, stop smoking services. A total of 462 postpartum women (aged ≥ 16 years) took part, who stopped smoking during pregnancy with financial incentives, validated as abstinent from smoking at end of pregnancy or early postpartum.

Interventions
Interventions comprised (i) UC; (ii) UC plus up to £60 of financial voucher incentives offered to participants and £60 offered to an optional significant-other supporter, over 3 months postpartum, contingent upon validated abstinence (‘3-month incentives’); or (iii) UC plus ‘3-month incentives’ plus £180 of vouchers offered to participants over 9 months postpartum, contingent upon abstinence (‘12-month incentives’).

Measurements
Primary outcome: biochemically validated abstinence at 1 year postpartum. To adjust for testing all comparisons between groups with equal precision, P < 0.017 was necessary for significance. Secondary outcomes: self-reported and validated abstinence at 3 months postpartum; self-reported abstinence at 1 year postpartum.

Findings
Primary outcome ascertainment: abstinence was 39.6% (63/159) 12 months incentives, 21.4% (33/154) 3 months incentives and 28.2% (42/149) UC. Adjusted odds ratios [95% confidence interval (CI)] = 12-month versus 3-month incentives OR = 2.41 (95% CI = 1.46−3.96), P = 0.001; 12 months versus UC 1.67 (1.04−2.70), P = 0.035; 3 months versus UC 0.69 (0.41−1.17), P = 0.174. Bayes factors indicated that for 12-month versus 3-month incentives and 12 months versus UC there was good evidence for the alternative hypothesis, and for 3 months versus UC there was good evidence for the null hypothesis.

Conclusions
This randomized controlled trial provides weak evidence that up to £300 of voucher incentives over 12 months is effective for maintaining smoking abstinence postpartum compared with usual care. There was good evidence that 12-month incentives are superior to those over only 3 months, for which there was no evidence of effectiveness relative to usual care.

Citation

Lewis, S., Mckell, J., Coleman, T., Cooper, S., Orton, S., Bauld, L., & Usher, J. (2024). Effect of 3 months and 12 months of financial incentives on 12-month postpartum smoking cessation maintenance: a randomised controlled trial. Addiction, 119(8), 1352-1363. https://doi.org/10.1111/add.16487

• Journal Article Type: Article
• Acceptance Date: Feb 28, 2024
• Online Publication Date: Apr 16, 2024
• Publication Date: 2024-08
• Deposit Date: Feb 29, 2024
• Publicly Available Date: Feb 29, 2024
• Print ISSN: 0965-2140
• Electronic ISSN: 1360-0443
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 119
• Issue: 8
• Pages: 1352-1363
• DOI: https://doi.org/10.1111/add.16487
• Public URL: https://nottingham-repository.worktribe.com/output/31892711
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/add.16487