Using Incentives to Encourage Smoking Abstinence Among Pregnant Indigenous Women? A Feasibility Study

Abstract

Smoking during pregnancy increases the risk of many adverse health outcomes for both the mother and the unborn child (Morton et al. 2010). Indigenous people often have a higher smoking prevalence during pregnancy than non-Indigenous populations. In New Zealand (NZ), the smoking rates among Indigenous Māori women who are pregnant have reduced since 1991 (68%) but still remains high in 2007 (34%) (Morton et al. 2010). The success rate of most smoking cessation interventions for pregnant smokers is low at <6% (Lumley et al. 2009). In other populations of pregnant women, financial incentives have been shown to increase the attractiveness of smoking cessation programs and increase the number of quit attempts. A feasibility studywas undertaken to determine the likely effectiveness of an incentives-based cessation trial among pregnant Māori women that smoked. Pregnant smokers, aged 16years and older, who self-identified as Māori, were 2-30weeks pregnant, and currently smoked, were recruited through health practitioners, print media, and radio adverts in Auckland, NZ. Participants were randomised to (1) usual cessation support, including information about different cessation products and services, and access to nicotine replacement therapy (control), (2) usual cessation support plus a retail voucher to the value of NZ$25for each ‘abstinent from smoking' week for 8 weeks (voucher), or (3) usual cessation support plus product to the value of NZ$25 for each ‘abstinent from smoking' week for 8 weeks (product). Outcomes measures included weekly self-reported and monthly biochemically verified smoking status, and acceptability. Of the 74 referred women, 50 declined involvement in the study and 24 consented and were randomised (eight control, eight voucher and eight to product). The mean age of participants was 25years old (±2.25). Overall 21% (n=5) of the women were abstinent from smoking for at least 6 weeks of the eight, one from the control, six from the product and three from the voucher. Our findings suggest that incentives, in particular a choice of products, may be an effective addition to usual care to increase smoking cessation among pregnant Māori women, which has the potential to improve health outcomes for both the mother and child.