RESEARCH
Financial incentives for smoking cessation in pregnancy: randomised controlled trial The authors describe their paper in a video abstract ЖЖEDITORIAL by Murphy 1
PEACH Unit, Child Health, Glasgow University, Yorkhill, Glasgow G3 8SJ, UK 2 Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK 3 Strathclyde University, Glasgow, UK 4 Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, Glasgow University, Glasgow, UK 5 Public Health, NHS Greater Glasgow and Clyde, Glasgow, UK 6 Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Glasgow University, Glasgow, UK 7 Glasgow Centre for Population Health, Glasgow, UK 8 Directorate of Public Health, NHS Tayside, Dundee, UK 9 Division of Primary Care and, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK Correspondence to: D Tappin [email protected] Cite this as: BMJ 2015;350:h134 doi: 10.1136/bmj.h134
This is a summary of a paper that was published on thebmj.com as BMJ 2015;350:h134
thebmj.com ̻̻Editorial: Helping pregnant smokers to quit (BMJ 2014;348:g1808) ̻̻Clinical Review: Supporting smoking cessation (BMJ 2014;348:f7535) ̻̻Editorial: Smoking in pregnancy (BMJ 2009;338:b2188)
David Tappin,1 Linda Bauld,2 David Purves,3 Kathleen Boyd,4 Lesley Sinclair,2 Susan MacAskill,2 Jennifer McKell,2 Brenda Friel,5 Alex McConnachie,6 Linda de Caestecker,5 Carol Tannahill,7 Andrew Radley,8 Tim Coleman,9 for the Cessation in Pregnancy Incentives Trial (CPIT) Team STUDY QUESTION Does the offer of up to £400 of shopping vouchers added to routine UK National Health Service specialist pregnancy stop smoking services help pregnant smokers quit compared with routine support alone?
nity booking to specialist pregnancy stop smoking services in one large health board area in the west of Scotland. Participants spoke English, were aged 16 years or more, were less than 24 weeks pregnant, and had a carbon monoxide breath test result of 7 ppm or more.
SUMMARY ANSWER The offer of financial incentives added to specialist pregnancy stop smoking services more than doubled the quit rate among pregnant smokers, from 9% to 23%.
Primary outcome The primary outcome was cotinine verified cessation at 34-38 weeks’ gestation towards the end of pregnancy (about six months after maternity booking). We corroborated self reported “quits” by cotinine assay on saliva or urine collected by a research nurse at a home visit.
WHAT IS KNOWN AND WHAT THIS PAPER ADDS Smoking during pregnancy causes major mortality and morbidity, which costs the NHS £10s of millions in extra healthcare spending each year; current recommended interventions are not very effective. In this large phase II trial, financial incentives used as an adjunct to routine smoking cessation support helped pregnant smokers to stop smoking.
Design This was a phase II therapeutic exploratory, single centre, parallel group, individually randomised controlled superiority trial. Computer generated concealed randomisation with permuted blocks, with a block length of 4, was used. Initial primary outcome assessment was blind to random allocation. Both trial groups were offered routine care—support from a specialist pregnancy stop smoking service. We additionally offered the intervention group participants financial incentives, as shopping vouchers, to a maximum of £400. The vouchers were offered at four time points throughout pregnancy and contingent initially on attending an appointment with an adviser from the stop smoking services and setting a quit date, and subsequently on demonstrating validated abstinence from smoking. Participants and setting Between December 2011 and February 2013 we enrolled 612 self reported pregnant smokers, referred from mater-
Self report smoking status at 34-38 weeks’ gestation verified by cotinine No (%) Data item
Self reported smoking status: Smoker Lost to follow-up Non-smoker Primary outcome: Self reported non-smoker and saliva or urine cotinine negative
Incentives group (n=306)*
Control groups (n=303)†
Relative risk of not smoking (95% CI)
139 (45.4) 46 (15.1) 119 (38.9)
195 (64.3) 43 (14.2) 65 (21.5)
— — 1.81 (1.41 to 2.35)
69 (22.5)
26 (8.6)
2.63 (1.73 to 4.01)
*Consent withdrawn post-randomisation (after 12 week stage) for two women in incentives group (consent given to analyse data collected). †Consent withdrawn post-randomisation for three women in control group (consent withdrawn to utilise data collected).
Main results and the role of chance Significantly more smokers in the incentives group stopped smoking: 69 (22.5%) versus 26 (8.6%). The relative risk of not smoking at the end of pregnancy was 2.63 (95% confidence interval 1.73 to 4.01), P
Financial incentives for smoking cessation in pregnancy: randomised controlled trial The authors describe their paper in a video abstract ЖЖEDITORIAL by Murphy 1
PEACH Unit, Child Health, Glasgow University, Yorkhill, Glasgow G3 8SJ, UK 2 Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK 3 Strathclyde University, Glasgow, UK 4 Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, Glasgow University, Glasgow, UK 5 Public Health, NHS Greater Glasgow and Clyde, Glasgow, UK 6 Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Glasgow University, Glasgow, UK 7 Glasgow Centre for Population Health, Glasgow, UK 8 Directorate of Public Health, NHS Tayside, Dundee, UK 9 Division of Primary Care and, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK Correspondence to: D Tappin [email protected] Cite this as: BMJ 2015;350:h134 doi: 10.1136/bmj.h134
This is a summary of a paper that was published on thebmj.com as BMJ 2015;350:h134
thebmj.com ̻̻Editorial: Helping pregnant smokers to quit (BMJ 2014;348:g1808) ̻̻Clinical Review: Supporting smoking cessation (BMJ 2014;348:f7535) ̻̻Editorial: Smoking in pregnancy (BMJ 2009;338:b2188)
David Tappin,1 Linda Bauld,2 David Purves,3 Kathleen Boyd,4 Lesley Sinclair,2 Susan MacAskill,2 Jennifer McKell,2 Brenda Friel,5 Alex McConnachie,6 Linda de Caestecker,5 Carol Tannahill,7 Andrew Radley,8 Tim Coleman,9 for the Cessation in Pregnancy Incentives Trial (CPIT) Team STUDY QUESTION Does the offer of up to £400 of shopping vouchers added to routine UK National Health Service specialist pregnancy stop smoking services help pregnant smokers quit compared with routine support alone?
nity booking to specialist pregnancy stop smoking services in one large health board area in the west of Scotland. Participants spoke English, were aged 16 years or more, were less than 24 weeks pregnant, and had a carbon monoxide breath test result of 7 ppm or more.
SUMMARY ANSWER The offer of financial incentives added to specialist pregnancy stop smoking services more than doubled the quit rate among pregnant smokers, from 9% to 23%.
Primary outcome The primary outcome was cotinine verified cessation at 34-38 weeks’ gestation towards the end of pregnancy (about six months after maternity booking). We corroborated self reported “quits” by cotinine assay on saliva or urine collected by a research nurse at a home visit.
WHAT IS KNOWN AND WHAT THIS PAPER ADDS Smoking during pregnancy causes major mortality and morbidity, which costs the NHS £10s of millions in extra healthcare spending each year; current recommended interventions are not very effective. In this large phase II trial, financial incentives used as an adjunct to routine smoking cessation support helped pregnant smokers to stop smoking.
Design This was a phase II therapeutic exploratory, single centre, parallel group, individually randomised controlled superiority trial. Computer generated concealed randomisation with permuted blocks, with a block length of 4, was used. Initial primary outcome assessment was blind to random allocation. Both trial groups were offered routine care—support from a specialist pregnancy stop smoking service. We additionally offered the intervention group participants financial incentives, as shopping vouchers, to a maximum of £400. The vouchers were offered at four time points throughout pregnancy and contingent initially on attending an appointment with an adviser from the stop smoking services and setting a quit date, and subsequently on demonstrating validated abstinence from smoking. Participants and setting Between December 2011 and February 2013 we enrolled 612 self reported pregnant smokers, referred from mater-
Self report smoking status at 34-38 weeks’ gestation verified by cotinine No (%) Data item
Self reported smoking status: Smoker Lost to follow-up Non-smoker Primary outcome: Self reported non-smoker and saliva or urine cotinine negative
Incentives group (n=306)*
Control groups (n=303)†
Relative risk of not smoking (95% CI)
139 (45.4) 46 (15.1) 119 (38.9)
195 (64.3) 43 (14.2) 65 (21.5)
— — 1.81 (1.41 to 2.35)
69 (22.5)
26 (8.6)
2.63 (1.73 to 4.01)
*Consent withdrawn post-randomisation (after 12 week stage) for two women in incentives group (consent given to analyse data collected). †Consent withdrawn post-randomisation for three women in control group (consent withdrawn to utilise data collected).
Main results and the role of chance Significantly more smokers in the incentives group stopped smoking: 69 (22.5%) versus 26 (8.6%). The relative risk of not smoking at the end of pregnancy was 2.63 (95% confidence interval 1.73 to 4.01), P
