Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America.
Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America.
Prev Med. 2022 Dec;165(Pt B):107012. doi: 10.1016/j.ypmed.2022.107012. Epub 2022 Mar 3.
We report results from a single-blinded randomized controlled trial examining financial incentives for smoking cessation among 249 pregnant and newly postpartum women. Participants included 169 women assigned to best practices (BP) or BP plus financial incentives (BP + FI) for smoking cessation available through 12-weeks postpartum. A third condition included 80 never-smokers (NS) sociodemographically-matched to women who smoked. Trial setting was Burlington, Vermont, USA, January, 2014 through January, 2020. Outcomes included 7-day point-prevalence abstinence antepartum and postpartum, and birth and other infant outcomes during 1st year of life. Reliability and external validity of results were assessed using pooled results from the current and four prior controlled trials coupled with data on maternal-smoking status and birth outcomes for all 2019 singleton live births in Vermont. Compared to BP, BP + FI significantly increased abstinence early- (AOR = 9.97; 95%CI, 3.32-29.93) and late-pregnancy (primary outcome, AOR = 5.61; 95%CI, 2.37-13.28) and through 12-weeks postpartum (AOR = 2.46; CI,1.05-5.75) although not 24- (AOR = 1.31; CI,0.54-3.17) or 48-weeks postpartum (AOR = 1.33; CI,0.55-3.25). There was a significant effect of trial condition on small-for-gestational-age (SGA) deliveries (χ [2] = 9.01, P = .01), with percent SGA deliveries (+SEM) greatest in BP, intermediate in BP + FI, and lowest in NS (17.65 + 4.13, 10.81 + 3.61, and 2.53 + 1.77, respectively). Reliability analyses supported the efficacy of financial incentives for increasing abstinence antepartum and postpartum and decreasing SGA deliveries; external-validity analyses supported relationships between antepartum cessation and SGA risk. Adding financial incentives to Best Practice increases smoking cessation among antepartum and postpartum women and improves other maternal-infant outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02210832.
我们报告了一项单盲随机对照试验的结果，该试验考察了为 249 名孕妇和产后不久的女性提供戒烟经济激励措施的效果。参与者包括 169 名被分配到最佳实践（BP）或 BP 加戒烟经济激励（BP+FI）的女性，这些激励措施可在产后 12 周内使用。第三个条件包括 80 名从不吸烟的（NS）女性，这些女性在社会人口统计学上与吸烟的女性相匹配。试验地点为美国佛蒙特州伯灵顿，时间为 2014 年 1 月至 2020 年 1 月。结果包括产前和产后 7 天的点前戒烟率，以及婴儿出生后第一年的出生和其他婴儿结局。使用当前和之前四项对照试验的汇总结果以及佛蒙特州所有 2019 年单胎活产儿的母亲吸烟状况和出生结局数据，评估了结果的可靠性和外部有效性。与 BP 相比，BP+FI 显著增加了早期（AOR=9.97；95%CI，3.32-29.93）和晚期妊娠（主要结局，AOR=5.61；95%CI，2.37-13.28）以及产后 12 周（AOR=2.46；CI，1.05-5.75）的戒烟率，尽管在 24 周（AOR=1.31；CI，0.54-3.17）和 48 周（AOR=1.33；CI，0.55-3.25）时没有显著效果。试验条件对小于胎龄儿（SGA）分娩有显著影响（χ[2]=9.01，P=0.01），BP 组的 SGA 分娩率最高（+SEM），BP+FI 组次之，NS 组最低（分别为 17.65+4.13、10.81+3.61 和 2.53+1.77）。可靠性分析支持经济激励措施在增加产前和产后戒烟率以及降低 SGA 分娩率方面的疗效；外部有效性分析支持产前戒烟与 SGA 风险之间的关系。在最佳实践中加入经济激励措施可提高产前和产后女性的戒烟率，并改善其他母婴结局。临床试验注册：ClinicalTrials.gov 标识符：NCT02210832。
