Financial Incentives for Smoking Cessation Among Disadvantaged Pregnant Women

弱势孕妇戒烟的经济激励

基本信息

批准号：
8852000
负责人：
Stephen T Higgins
金额：
$ 71.8万
依托单位：
UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-15 至 2016-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8852000
关键词：
Abdomen Abstinence Admission activity Area Birth Birth Weight Breast Feeding Characteristics Childhood Clinic Consensus Controlled Study Cost Analysis Cost Savings Counseling Data Developed Countries Disadvantaged Economic Burden Economically Deprived Population Economics Effectiveness Femur Fetal Growth Fetal Weight Gestational Age Growth Guidelines Health Healthcare Hospital Records Incentives Infant Infant Health Intervention Knowledge Length Low Birth Weight Infant Medicaid Meta-Analysis Modeling Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Pharmaceutical Preparations Policies Population Postpartum Period Pregnancy Pregnancy Complications Pregnancy Outcome Pregnant Women Prenatal care Randomized Randomized Clinical Trials Randomized Controlled Clinical Trials Recruitment Activity Relative (related person)Reporting Research Risk Sick Role Smoker Smoking Smoking Status Telephone Visit Withholding Treatment Woman base behavioral economics cardiovascular disorder risk comparative efficacy control trial cost cost effective cost effectiveness design effective intervention effective therapy fetal tobacco exposure financial incentive health disparity health economics high risk improved infant death infant outcome meetings non-smoker non-smoking novel pregnant prospective public health relevance quitline smoking cessation socioeconomics trend trial comparing

项目摘要

DESCRIPTION (provided by applicant): Smoking during pregnancy is the leading preventable cause of poor pregnancy outcomes in the U.S. Most pregnant smokers continue smoking through pregnancy producing serious immediate and longer-term adverse health consequences for the infant. Smoking during pregnancy is highly associated with economic disadvantage and a substantive contributor to health disparities. Efficacious interventions are available but cessation rates are low (<20 percent) and improvements in birth outcomes often modest or absent. Current treatments usually entail relatively brief, low-cost interventions (e.g. pregnancy-specific quit lines). There is broad consensus that more effective interventions are sorely needed. We have developed a novel behavioral-economic intervention in which women earn financial incentives contingent on smoking abstinence. In a meta-analysis of treatments for smoking during pregnancy, effect sizes achieved with financial incentives were several-fold larger than those achieved with lower-intensity approaches or medications. The intervention also appears to improve birth outcomes and increase breastfeeding duration. While highly promising, further research is needed in at least three areas. (1) The evidence on birth outcomes and breastfeeding is from studies that combined data across trials rather than a single prospective trial, (2) whether the intervention produces other postpartum improvements in health has not been investigated, and (3) the overall cost-effectiveness of this approach has not been examined. To examine these unanswered questions, we are proposing a randomized, controlled clinical trial comparing the efficacy and cost effectiveness throuh one-year postpartum of current best practices for smoking-cessation during pregnancy vs. best practices plus financial incentives among 230 pregnant, Medicaid recipients. We will also include a third condition of 115 pregnant non-smokers matched to the smokers on socio-demographic and health conditions to compare the extent to which the treatments reduce the burden of smoking and to estimate how much more might be accomplished by further improvements in this incentives intervention without exceeding cost-effectiveness. We hypothesize that best practices plus financial incentives will be more effective than best practices alone, that the incentives intervention will be cost effective, and that while adding the incentives reduces a greater proportion of the health and economic burden of smoking than best practices alone, more can be done while remaining cost effective. Overall, the proposed study has the potential to substantially advance knowledge on cost-effective smoking cessation for pregnant women. Importantly, because of the strong association between smoking during pregnancy and economic disadvantage, the proposed study also has the potential to contribute new knowledge relevant to reducing the serious challenges of health disparities.

描述（由申请人提供）：在美国，怀孕期间吸烟是导致妊娠结局不佳的主要可预防原因。大多数怀孕吸烟者在怀孕期间继续吸烟，对婴儿产生严重的直接和长期不良健康后果。怀孕期间吸烟与经济劣势高度相关，也是造成健康差异的一个重要因素。有效的干预措施是可行的，但戒烟率很低（<20%），而且出生结果的改善往往不大或根本没有。目前的治疗通常需要相对简短、低成本的干预措施（例如针对怀孕的戒烟热线）。人们普遍认为迫切需要更有效的干预措施。我们开发了一种新颖的行为经济干预措施，女性可以根据戒烟情况获得经济奖励。在对怀孕期间吸烟治疗的荟萃分析中，通过经济激励实现的效果比通过低强度方法或药物实现的效果大几倍。该干预措施似乎还可以改善出生结果并延长母乳喂养时间。虽然前景广阔，但至少需要在三个领域进行进一步的研究。 (1) 关于出生结局和母乳喂养的证据来自综合试验数据而不是单一前瞻性试验的研究，(2) 干预措施是否会产生其他产后健康改善尚未得到调查，(3) 总体成本这种方法的有效性尚未得到检验。为了研究这些悬而未决的问题，我们提出了一项随机对照临床试验，比较目前怀孕期间戒烟最佳做法与产后一年内戒烟的效果和成本效益。向 230 名怀孕的医疗补助受益人提供最佳实践和经济激励。我们还将纳入与吸烟者相匹配的 115 名怀孕非吸烟者的第三个条件社会人口和健康状况，以比较治疗方法减轻吸烟负担的程度，并估计在不超出成本效益的情况下进一步改进这种激励干预措施可以取得多少成果。我们假设，最佳实践加上经济激励措施将比单独的最佳实践更有效，激励措施干预将具有成本效益，并且与单独的最佳实践相比，增加激励措施可以更大程度地减少吸烟的健康和经济负担，可以在保持成本效益的同时完成。总体而言，拟议的研究有可能大大提高对孕妇有效戒烟的认识。重要的是，由于怀孕期间吸烟与经济劣势之间存在密切关联，拟议的研究还有可能贡献与减少健康差异的严重挑战相关的新知识。