CORVALLIS - The surprising success of an Oregon State University smoking cessation study aimed at low-income pregnant women has resulted in a new four-year, $850,000 grant from the prestigious Robert Wood Johnson Foundation.
The OSU study found that regular cash incentives - to pregnant women and their social support partners - led to one of the highest smoking cessation rates ever recorded. A total of 34 percent of the women in the study who received $50 monthly cash vouchers had quit smoking by the time they gave birth, compared to 9 percent in the control group.
Smoking cessation rates rarely surpass 14 percent, experts say.
"Some people question the strategy of giving pregnant women money to do what 'they should be doing anyway,'" said Rebecca Donatelle, an associate professor of public health at OSU and principal investigator for the study. "If you set aside the ethical debate for a moment and look at the financial implications, they are profound.
"New economic estimates indicate that direct medical costs of a complicated birth for smokers are 66 percent higher than for non-smokers, reflecting the intensive medical care required," she added. "That doesn't begin to address the potential health problems these babies, their families, or the smoking mothers will have throughout their lifetimes. Smoking consequences - ranging from cancers, asthma and other respiratory diseases and risks - add up to one of the costliest health problems in our society today.
"It's a question of paying a relatively small amount now for prevention, or paying many times that amount later for costly tobacco-related illnesses."
The Robert Wood Johnson Foundation also supported the earlier OSU study. Oregon State will use the new $850,000 grant to determine what level of financial support provides sufficient incentive for pregnant women at managed care prenatal clinics to quit smoking.
During the first studies, the OSU researchers worked with volunteers in the Women, Infant and Children (WIC) program. This time, Donatelle is partnering with the Providence Health System through its Oregon-based Center for Outcomes Research and Education and with affiliated clinics, as well as health care providers in Salem, Corvallis and Eugene.
All of these clinics will follow the "best practice" guidelines for dealing with patients who smoke, Donatelle said.
These guidelines include identifying smokers, assessing their habits, advising them on health risks, assisting them in quitting, and providing follow-up counseling and education.
"OSU will follow up with an incentive program that will continue throughout their pregnancy and six months post-partum," Donatelle said. "We're excited about the possibilities." Women in the study are biochemically tested for compliance with both saliva cotinine and expired carbon monoxide procedures.
The new OSU study will begin this October, when the researchers begin working with 600 to 1,000 pregnant women in Oregon in what will be one of the nation's largest, randomized controlled studies to test such an incentive-based model in clinical practice.
"The health care workers who we've worked with at different clinics have been extremely cooperative," Donatelle said. "They recognize the problem and are highly motivated to do whatever they can to help women reduce or quit smoking entirely.
"In spite of all of the problems we often hear about managed care," she added, "it is important to recognize that managed care groups consist of dedicated health professionals who care very much about doing the right thing for patients."
Other researchers who will be part of the study include Deanne Hudson, of OSU, an RN with a master's in public health who will serve a key role as project coordinator and investigator; Edward Lichtenstein, Ph.D., a senior research scientist at the Oregon Research Institute; Michael Wall, an M.D. with Oregon Health Sciences University; and Nancy Davis, director of health services research for Providence.
The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care.