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（申请人提供）：在怀孕期间吸烟是美国大多数怀孕妊娠结局不良的主要原因，大多数怀孕的吸烟者继续通过妊娠吸烟，从而对婴儿产生严重的直接和长期不良健康后果。怀孕期间的吸烟与经济劣势高度相关，并且是对健康差异的实质性贡献。有有效的干预措施，但戒烟率较低（<20％），而出生结果的改善通常适中或不存在。当前的治疗通常需要相对短暂的低成本干预措施（例如，特定于妊娠的戒烟线）。人们普遍认为，迫切需要更有效的干预措施。我们已经开发了一种新颖的行为经济干预措施，在这种干预中，妇女获得了因戒烟而取决于的经济激励措施。在怀孕期间吸烟治疗的荟萃分析中，经济激励措施实现的效果尺寸比使用较低强度的方法或药物实现的效果要大几倍。干预似乎还可以改善出生结果并增加母乳喂养持续时间。虽然很有希望，但至少需要三个领域需要进一步的研究。（1）关于出生结局和母乳喂养的证据来自于跨试验而不是单个前瞻性试验结合数据的研究，（2）尚未研究干预措施是否会产生其他产后改善，并且（3）尚未检查这种方法的总体成本效益。为了检查这些未解决的问题，我们提出了一项随机，对照临床试验，比较了一年的产后一年的疗效和成本效益，这是当前最佳实践在怀孕期间吸烟中的最佳实践。最佳实践以及230名怀孕的医疗补助接收者中的经济激励措施。我们还将包括与吸烟者相匹配的115个怀孕的非吸烟者的第三个条件关于社会人口统计学和健康状况，以比较治疗的程度减轻吸烟的负担，并通过进一步改善这种激励措施干预而不超过成本效益来估计可以实现多少更多。我们假设最佳实践和经济激励措施将比单独的最佳实践更有效，即激励措施将是具有成本效益的，并且在增加激励措施的同时，减少了比单独使用最佳实践的健康和经济负担的比例更大，但可以在剩余的成本效益的同时完成更多的效果。总体而言，这项拟议的研究有可能大大提高人们对孕妇的成本效益戒烟的知识。重要的是，由于怀孕期间的吸烟与经济劣势之间存在密切的联系，因此拟议的研究还有可能为减少健康差异的严重挑战而贡献新的知识。