In a large collaborative study spearheaded by the University of East Anglia in partnership with the University of Oxford, the University of Edinburgh, and the University of Massachusetts Amherst, researchers explored whether incentives were effective in helping pregnant women to give up smoking. They also examined broader populations who smoke and tested the impact of providing rewards such as cash, vouchers, or returned deposits.
“We wanted to find out if giving people rewards helps them to quit smoking in the long term," said Professor Caitlin Notley, lead author of the study from UEA’s Norwich Medical School.
According to the team, previous research found rewards played a moderate role in encouraging pregnant women to quit smoking. The latest findings now report “high certainty evidence” that reward schemes are successful in helping pregnant women quit, and that “we are now very confident that incentives help people, and pregnant people, to quit smoking better than not offering incentives.” Notley also stated, “The evidence also demonstrates that the effectiveness of incentives lasts even after rewards have stopped.”
The researchers examined 48 studies that tested different reward schemes and recruited more than 21,900 participants. Of these, 39 studies involving 18,303 people showed that those receiving rewards were more likely to have stopped smoking six months or more after the beginning of the trial. Once the lowest-quality trials were removed, the results remained consistent. For every 100 people who received financial incentives, 10 were likely to successfully quit smoking at six months or longer, compared to 7 in 100 who did not receive incentives. Success rates continued beyond when the incentives had ended.
Women who were pregnant saw even greater benefits. One part of the analysis looked at 13 studies involving 3,942 people, revealing a substantial boost for those provided with rewards. “Women who were pregnant and received rewards were much more likely to stop smoking than those in the control groups,” the research team noted, and this held true both at the end of the pregnancy and after the baby was born. For every 100 pregnant women offered incentives, 13 were likely to stop smoking at six months or more, compared to 6 in 100 without such schemes.
Studies varied in total amounts of rewards paid, ranging from smaller sums (fewer than 100 US dollars) to larger amounts (more than 700 US dollars). There was no noticeable difference in effectiveness tied to reward size, though the researchers pointed out that money holds different levels of importance across cultures, and the studies came from many different countries. “Such incentive schemes can be run in workplaces, clinics, and sometimes as community programmes,” the research team commented.
Professor Linda Bauld, Director of the SPECTRUM Research Consortium, Co-Chair of the Smoking in Pregnancy Challenge Group, and study co-author, said: “Smoking during pregnancy is one of the leading causes of poor birth outcomes including stillbirth and miscarriage.” She added, “These findings show that financial incentives during pregnancy can more than double the chances of quitting smoking and that incentives are also effective for preventing women from relapsing to smoking postnatally.” In her view, “This evidence supports the case for continued investment in the existing national financial incentive scheme for pregnant women in England.”
Co-author Jamie Hartmann-Boyce, assistant professor of health policy and promotion at the University of Massachusetts Amherst, noted: “People are more cautious in pregnancy about using a lot of the pharmacological interventions that are approved for smoking cessation. So that’s why we’re focused on ways that we can help pregnant people quit smoking.” She highlighted that there is “a lot of evidence to suggest that this intervention is acting on the psychological reward systems in the brain, which we know are heavily involved with nicotine addiction.” She also clarified, “It’s not that these people could have quit anyway and then were paid and decided to do so. A lot of people in these studies have tried to quit many times, they really want to quit and weren’t able to do so, and this helped them.”
According to the team, current and future research might explore differences between low or high cash incentives and self-incentives (deposits) in a wider range of populations, including low- and middle-income countries where the burden of tobacco use remains high.
The article was written with the assistance of a news analysis system.