Financial rewards significantly increase smoking cessation rates, even during pregnancy

Rewards and financial incentives are successful methods of helping people quit smoking, according to a new study Cochrane review co-led by a public health and health policy researcher from the University of Massachusetts Amherst. For the first time, the researchers also found ‘very certain evidence’ that this intervention also works in pregnant people.

An earlier review of studies, also published in the Cochrane database of systematic reviewsfound moderate certainty that financial rewards played a role in encouraging the pregnant population to quit smoking.

“When we updated this review, we found more studies looking at financial incentives for people who are pregnant and this time we found high-confidence evidence that they do indeed help people who are pregnant quit smoking and quit,” said senior author Jamie Hartmann-Boyce . assistant professor of health policy and promotion at the School of Public Health and Health Sciences.

“We know that smoking during pregnancy can be very harmful to both the parent and the fetus,” says Hartmann-Boyce. “And people are more cautious during pregnancy about using many of the pharmacological interventions approved for smoking cessation. That’s why we’re focusing on ways we can help pregnant people quit smoking.”

The latest review included 47 studies in mixed populations in the US, Europe, Southeast Asia, Hong Kong and South Africa, including 14 new ones in this review, with just under 22,000 participants. The researchers again found “highly confident evidence” that financial incentives improve smoking cessation rates at long-term follow-up, even after the incentives are withdrawn.

Separately, the researchers looked at 13 studies from the US, UK and France, involving 3,942 pregnant people. Of every 100 pregnant people who received financial incentives, thirteen were likely to successfully quit smoking after six months or more, compared to six in 100 who did not receive financial incentives.

The financial amount, given in cash or vouchers, varied widely between the studies reviewed, from zero (out-of-pocket deposits returned to the smokers who quit) to between $45 and $1,185. The value of the incentive did not appear to be related to the quit rate. “We didn’t have enough evidence to find out whether offering different value rewards had an impact on smoking cessation,” the paper said.

The research was led by the University of East Anglia (UEA) in collaboration with UMass Amherst, the University of Oxford and the University of Edinburgh.

“Smoking is the leading preventable cause of ill health and premature death worldwide, and quitting smoking is crucial to helping people live longer in good health,” said lead author Caitlin Notley, professor of addiction sciences at the Norwich Medical School of the UEA. “We are now confident that incentives will help people, including pregnant people, quit smoking better than not offering incentives.”

Hartmann-Boyce notes that “many people are averse to the idea of ​​making payments available to people who use substances precisely because they use substances. But it would benefit us all if more people could quit smoking. “

She also points that out California became the first state to offer financial incentives, such as small-value gift cards, through Medicaid to people who stop using stimulants, such as methamphetamine and cocaine.

Also known as “contingency management,” this incentive program is considered the gold standard evidence-based approach to treating stimulant use disorders. Since California received federal approval to cover contingency management as a Medicaid benefit in 2021, fourteen more states have followed suit.

“The other common misconception about financial incentives is the idea that all these people are able to quit smoking, and they just couldn’t because they wouldn’t get paid for it,” says Hartmann-Boyce. ‘In fact, there is a lot of evidence to suggest that this intervention acts on the psychological reward systems in the brain, which we know are heavily involved in nicotine addiction.

“So it’s not like these people could have quit anyway and then got paid and decided to do that,” she adds. “Many people in these studies have tried to quit many times, they really wanted to quit but couldn’t, and this helped them.”