CORVALLIS - A new study at Oregon State University suggests that regular cash incentives as low as $50 a month may be the most effective method of getting low income pregnant women to quit smoking cigarettes.
Though education programs and counseling can play important roles, the OSU researchers say, they don't prove nearly as effective as cash vouchers - both for the pregnant women and their designated "social supporters," who might be partners, friends, neighbors or relatives.
When both received minor cash stipends, the pregnant women were 4-5 times more likely to quit smoking cigarettes than their counterparts in a control group that received the same counseling and education, but no money.
Results of the study will be presented March 9-13 by OSU researcher Susan L. Prows in the keynote address at the Air Force Worldwide Prevention Conference, sponsored by the U.S. Air Force and the U.S. Surgeon General.
Rebecca J. Donatelle, chair and associate professor of the Department of Public Health, and Prows, an assistant professor of public health, conducted the study under a grant by the Robert Wood Johnson Foundation.
"The findings are surprising in that they are so strong," Prows said. "Self-reported quit rates for cigarette smoking rarely exceed 14 percent, yet at the eight-month gestation period, our study - which had biochemical confirmation - showed that 34 percent of the women receiving cash vouchers had quit smoking compared to 9 percent in the control group."
At two months after delivery, 24 percent of the women receiving payments were still off cigarettes, compared to 5 percent of the control group.
"Getting pregnant women to quit smoking is vital because low birth weight is one of the most common - and costly - results," Donatelle said. "You end up having a lot of premature births and compromised immune systems, which send health costs skyrocketing."
The OSU researchers looked at 220 women who qualified for Women, Infant and Children (WIC), a food supplement and education program for low-income women and families offered through the U.S. Department of Agriculture and administered through county health departments.
All of the women in the study received counseling on the dangers of smoking to their unborn child, as well as a self-help kit that included a 10-step guide to quitting smoking. Half of the women were then put into a control group, while the other half were given monthly $50 vouchers if they quit. In addition, their support partner received a $50 voucher for the first and last month of the program, and a $25 voucher for all months in between. The vouchers could be redeemed at local Fred Meyer stores.
The women were biochemically tested for non-smoking compliance with both saliva cotinine and saliva thiocyanate tests.
"The obvious question that comes up is why should we be paying women for doing what they should be doing anyway - protecting the health of their children," Prows said. "The answer is that it may cost us a lot more as a society if we don't pay."
Private insurance companies, hospitals and managed health care systems - who had a strong interest in the study - provided the money for the vouchers.
Prows said the women involved in the study liked the "positive nature" of the research initiative that focused on incentives and a supporting partner instead of guilt trips and lecturing.
"They know about the risks of smoking and were glad for some acknowledgment that quitting is not that simple," Prows said. "There was no one 'beating them over the head' and making them feel evil."
For the one out of three women who quit smoking, the financial rewards actually were greater than $50, Donatelle pointed out. They also saved on the cost of cigarettes.
"Surprisingly, most of the women say that the rising costs of cigarettes through tobacco taxes is not really a deterrent, which raises some alarming possibilities," Donatelle said. "Considering that some of these women have very little income, they may be spending grocery money on cigarettes.
"There were some poignant stories, too," she added. "For some women, those vouchers were the only way they could buy Christmas presents for their families."
Most of the women in the study were young, though ages ranged from 15-42, and they were relatively light smokers - from 10 cigarettes to two packs a day. Many came from a constant smoking environment, however, where their friends, families and co-workers included heavy smokers. Smoking, they said, provided one of their "few pleasures."
The next step for the OSU researchers will be to determine the importance of the cash payments aimed at the supporting partners. They have received another grant from the Robert Wood Johnson Foundation to conduct a second phase of research.
The foundation sponsors a national program called the Smoke-Free Family Initiative and supported 11 different projects over the last two years, including the study by Donatelle and Prows. The OSU study was, by far, the most effective in getting smokers to quit and to stay off cigarettes.
"We know that social support is believed to be a strong factor in weight control," Donatelle said. "Our study carried the buddy-system idea a step farther."