Abstract:

Objective: Evaluate the effectiveness of monetary incentives for increasing engagement in smoking cessation treatment and improving 6-month abstinence in low-income pregnant smokers. Method: Two-group randomized clinical trial recruiting low-income (Medicaid-registered) pregnant smokers receiving assistance through a perinatal support program. Participants were randomized to either an incentive (n = 505) or control condition (n = 509). All participants were offered identical smoking cessation counseling at contacts. Incentive condition participants received incentives for attending pre- and postbirth treatment contacts: $25 for each of 6 prebirth provider visits, $25–40 for each of 4 postbirth home visits at Weeks 1, 2, 4, and 6 (total $130), $20 for each of 5 postbirth counseling calls and $40 for biochemically verified abstinence at the Week 1 and 6-month visits. Control condition participants received only $40 for attendance at the Week 1 and 6-month postbirth visits ($40 each). Results: Incentive condition participants had a higher biochemically confirmed abstinence rate at 6-month postbirth than controls (14.7% vs. 9.2%, respectively: p .01). This effect was mediated by incentive condition participants’ greater acceptance of postbirth home visits and counseling calls. Conclusions: Moderate incentive payments for smoking treatment engagement (a mean of $214 paid) increased low-income pregnant smokers’ engagement and success in smoking cessation treatment.