基于智能手机的经济激励措施以促进孕期戒烟：一项试点研究。
Smartphone-based financial incentives to promote smoking cessation during pregnancy: A pilot study.
机构信息
Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA.
Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA.
出版信息
Prev Med. 2020 Nov;140:106201. doi: 10.1016/j.ypmed.2020.106201. Epub 2020 Jul 9.
Cigarette smoking during pregnancy increases risk for pregnancy complications, growth restriction, and other adverse health outcomes. The most effective intervention for reducing smoking during pregnancy is financial incentives contingent on biochemically-verified smoking abstinence. The present study examined the efficacy of a smartphone-based intervention whereby smoking monitoring and incentive delivery occurred remotely using a mobile app. If efficacious, this remote intervention would allow pregnant women residing in geographically remote areas to benefit from incentives-based cessation interventions. Sixty U.S. pregnant smokers were recruited between May 2018 to May 2019 via obstetrical clinics, Women, Infants, and Children (WIC) offices, and Facebook. Participants were assigned sequentially to one of two treatments: best practices alone (N = 30) or best practices plus financial incentives (N = 30). Outcomes were analyzed using repeated measures analysis based on generalized estimating equations (GEE). Seven-day point prevalence abstinence rates were greater in the incentives versus best practices arms early- (46.7% vs 20.0%, OR = 3.50, 95%CI = 1.11,11.02) and late-antepartum (36.7% vs 13.3%, OR = 3.76, 95%CI = 1.04,13.65), and four- (36.7% vs 10.0%, OR = 5.21, 95%CI = 1.28,21.24) and eight-weeks postpartum (40.0% vs 6.7%, OR = 9.33, 95%CI = 1.87,46.68), although not at the 12- (23.3% vs 10.0%, OR = 2.74, 95%CI = 0.63,11.82) or 24-week (20.0% vs 6.7%, OR = 3.50, 95%CI = 0.65,18.98) postpartum assessments likely due to this pilot study being underpowered for discerning differences at the later assessments, especially 24-weeks postpartum which was three months after treatment completion. These results support the efficacy of this remote, incentives-based intervention for pregnant smokers. Further research evaluating its efficacy and cost-effectiveness in a well-powered, randomized controlled trial appears warranted.
怀孕期间吸烟会增加妊娠并发症、生长受限和其他不良健康结果的风险。减少怀孕期间吸烟最有效的干预措施是提供经济奖励，前提是通过生物化学方法验证吸烟行为的改变。本研究检验了一种基于智能手机的干预措施的效果，该措施通过移动应用程序远程进行吸烟监测和奖励发放。如果这种远程干预措施有效，那么居住在地理偏远地区的孕妇也可以受益于基于奖励的戒烟干预措施。2018 年 5 月至 2019 年 5 月期间，本研究通过产科诊所、妇女、婴儿和儿童（WIC）办公室和 Facebook 招募了 60 名美国孕妇。参与者被依次分配到以下两种治疗方法之一：最佳实践组（N=30）或最佳实践加经济奖励组（N=30）。使用广义估计方程（GEE）基于重复测量分析来分析结果。在早期（46.7% vs 20.0%，OR=3.50，95%CI=1.11,11.02）和晚期（36.7% vs 13.3%，OR=3.76，95%CI=1.04,13.65）、产后四周（36.7% vs 10.0%，OR=5.21，95%CI=1.28,21.24）和八周（40.0% vs 6.7%，OR=9.33，95%CI=1.87,46.68）时，奖励组的 7 天点预测量戒烟率更高，尽管在产后 12 周（23.3% vs 10.0%，OR=2.74，95%CI=0.63,11.82）和 24 周（20.0% vs 6.7%，OR=3.50，95%CI=0.65,18.98）时没有差异，这可能是由于本试点研究在后期评估中没有足够的功效来辨别差异，尤其是在治疗完成三个月后的 24 周时。这些结果支持这种远程、基于奖励的干预措施对孕妇吸烟者的有效性。进一步研究在一项有足够功效的随机对照试验中评估其效果和成本效益似乎是合理的。
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