A recent Cochrane review, co-led by a public health researcher from the University of Massachusetts Amherst, provides compelling evidence that financial incentives can effectively help pregnant people quit smoking. This updated review, including new data and research, has found “high-certainty evidence” that financial rewards encourage smoking cessation and long-term success, even after the rewards are withdrawn.
A prior Cochrane review found moderate certainty that financial rewards aided pregnant individuals in quitting smoking. However, the updated review—now with more studies and a larger participant group—reveals stronger evidence of its effectiveness. “We found high-certainty evidence that financial incentives help pregnant people quit smoking and stay quit,” said Jamie Hartmann-Boyce, senior author and assistant professor of health policy and promotion at UMass Amherst.
Smoking during pregnancy can severely harm both the parent and the fetus, which makes it a critical public health issue. Many pharmacological smoking cessation treatments are not recommended for pregnant individuals due to potential risks. This has led researchers to focus on alternative methods, such as financial incentives, to support smoking cessation during pregnancy.
The review analyzed 47 studies from various regions, including the U.S., Europe, Southeast Asia, Hong Kong, and South Africa, with nearly 22,000 participants. Among the studies, 13 specifically focused on pregnant individuals, involving 3,942 participants from the U.S., U.K., and France. The results were clear: for every 100 pregnant people who received financial incentives, 13 were likely to quit smoking for at least six months—double the quit rate of those who did not receive incentives.
The financial incentives varied widely, ranging from zero (self-deposits returned upon quitting) to amounts between $45 and $1,185. However, the value of the incentive did not correlate with higher success rates, meaning that even small rewards had a significant impact on smoking cessation.
The Cochrane review suggests that financial incentives not only improve short-term quit rates but also show positive long-term effects, even after the incentives are no longer available. This long-term success is important, as quitting smoking is a lifelong process, and the support during pregnancy can set the foundation for lasting changes.
Despite the strong evidence, some people are hesitant about using financial incentives to address smoking and other substance use issues. Critics often argue that paying people to quit might seem counterintuitive. However, Hartmann-Boyce emphasizes that the psychological reward systems in the brain are deeply involved in nicotine addiction. Many people who receive financial incentives have tried multiple times to quit without success. The incentives can help them overcome these barriers.
California’s pioneering use of financial incentives, such as small-value gift cards via Medicaid for quitting substances like methamphetamines and cocaine, has shown success. This model, known as “contingency management,” is now being adopted by other states. It is based on the evidence that incentives can stimulate behavior change, particularly when dealing with substance use disorders.
The findings of this review underline the importance of integrating financial incentives into public health strategies for smoking cessation, especially for vulnerable populations like pregnant individuals. The evidence confirms that these incentives are an effective and viable method to reduce smoking during pregnancy, offering long-term benefits to both the individual and society. The success of such programs suggests that they should be expanded to reach more people and help reduce smoking-related harms.
In conclusion, financial incentives not only help individuals quit smoking but also help break the cycle of addiction by addressing the psychological aspects of nicotine dependence. As the evidence grows, it is likely that more regions will adopt similar programs to support smoking cessation and improve public health outcomes.
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