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Darling EK, Jansen A, Jameel B, Tarride JÉ. A scoping review of costing methodologies used to assess interventions for underserved pregnant people and new parents. Int J Equity Health 2024; 23:168. [PMID: 39174995 PMCID: PMC11340114 DOI: 10.1186/s12939-024-02252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/12/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Lack of evidence about the long-term economic benefits of interventions targeting underserved perinatal populations can hamper decision making regarding funding. To optimize the quality of future research, we examined what methods and costs have been used to assess the value of interventions targeting pregnant people and/or new parents who have poor access to healthcare. METHODS We conducted a scoping review using methods described by Arksey and O'Malley. We conducted systematic searches in eight databases and web-searches for grey literature. Two researchers independently screened results to determine eligibility for inclusion. We included economic evaluations and cost analyses of interventions targeting pregnant people and/or new parents from underserved populations in twenty high income countries. We extracted and tabulated data from included publications regarding the study setting, population, intervention, study methods, types of costs included, and data sources for costs. RESULTS Final searches were completed in May 2024. We identified 103 eligible publications describing a range of interventions, most commonly home visiting programs (n = 19), smoking cessation interventions (n = 19), prenatal care (n = 11), perinatal mental health interventions (n = 11), and substance use treatment (n = 10), serving 36 distinct underserved populations. A quarter of the publications (n = 25) reported cost analyses only, while 77 were economic evaluations. Most publications (n = 82) considered health care costs, 45 considered other societal costs, and 14 considered only program costs. Only a third (n = 36) of the 103 included studies considered long-term costs that occurred more than one year after the birth (for interventions occurring only in pregnancy) or after the end of the intervention. CONCLUSIONS A broad range of interventions targeting pregnant people and/or new parents from underserved populations have the potential to reduce health inequities in their offspring. Economic evaluations of such interventions are often at risk of underestimating the long-term benefits of these interventions because they do not consider downstream societal costs. Our consolidated list of downstream and long-term costs from existing research can inform future economic analyses of interventions targeting poorly served pregnant people and new parents. Comprehensively quantifying the downstream and long-term benefits of such interventions is needed to inform decision making that will improve health equity.
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Affiliation(s)
- Elizabeth K Darling
- McMaster Midwifery Research Centre, McMaster University, 1280 Main St. W., HSC 4H24, Hamilton, ON, L8S 4K1, Canada.
| | - Aisha Jansen
- McMaster Midwifery Research Centre, McMaster University, 1280 Main St. W., HSC 4H24, Hamilton, ON, L8S 4K1, Canada
| | - Bismah Jameel
- McMaster Midwifery Research Centre, McMaster University, 1280 Main St. W., HSC 4H24, Hamilton, ON, L8S 4K1, Canada
| | - Jean-Éric Tarride
- Department of Health Research Methods, Evidence, and Impact, Communication Research Lab (CRL) 227, McMaster University, 1280 Main Street West, Hamilton, ON, L8K 4K1, Canada
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Aklin WM, Herrmann ES. National Institute on Drug Abuse (NIDA) research priorities to support the development of incentive-based treatments for substance use disorders. Prev Med 2023; 176:107650. [PMID: 37524231 DOI: 10.1016/j.ypmed.2023.107650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
The purpose of this commentary is to highlight current research priorities of National Institute on Drug Abuse (NIDA) Division of Therapeutics and Medical Consequences (DTMC) regarding the development and testing of incentive-based interventions for the treatment of substance use disorders (SUDs). This manuscript summarizes the NIH Stage Model for behavioral intervention development, briefly reviews existing research on incentive-based treatments for SUDs that falls within the scope of DTMC at NIDA and highlights the development of digital therapeutics-based incentive interventions as an exemplar and high priority area. We briefly review how digital therapeutics approaches may address some common limitations to dissemination of incentive-based interventions and highlight opportunities for integrating incentive-based approaches into pharmacotherapy efficacy trials. Finally, we mention several related funding opportunities for researchers interested in developing incentive-based approaches for SUD treatment. The overall goal of this commentary is to inform the research community of current NIDA priority areas for intervention development and funding.
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Affiliation(s)
- Will M Aklin
- National Institute on Drug Abuse, Division of Therapeutics and Medical Consequences, USA.
| | - Evan S Herrmann
- National Institute on Drug Abuse, Division of Therapeutics and Medical Consequences, USA
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Wiles SD, Lee JW, Nelson A, Petersen AB, Singh PN. Racial/Ethnic Disparities Impact the Real-World Effectiveness of a Multicomponent Maternal Smoking Cessation Program: Findings from the CTTP Cohort. Matern Child Health J 2023; 27:2038-2047. [PMID: 37589829 PMCID: PMC10564824 DOI: 10.1007/s10995-023-03753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Smoking during pregnancy adversely affects perinatal outcomes for both women and infants. We conducted a retrospective cohort study of the state-funded Comprehensive Tobacco Treatment Program (CTTP) - the largest maternal tobacco cessation program in San Bernardino County, California - to determine the real-world program effectiveness and to identify variables that can potentially improve effectiveness. METHODS During 2012-2019, women who smoked during pregnancy were enrolled in CTTP's multicomponent behavioral smoking cessation program that implemented components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). RESULTS We found that 40.1% achieved prolonged abstinence by achieving weekly, cotinine-verified, 7-day abstinence during 6 to 8 weeks of enrollment. Using intention-to-treat analyses, we computed that the self-reported point prevalence abstinence rate (PPA) at the six-month telephone follow-up was 36.7%. Cohort members achieving prolonged abstinence during the CTTP were five times more likely to achieve PPA six months after CTTP. Several non-Hispanic ethnicities (Black, Native American, White, or More than one ethnicity) in the cohort were two-fold less likely (relative to Hispanics) to achieve prolonged abstinence during CTTP or PPA at six months after CTTP. This disparity was further investigated in mediation analysis. Variables such as quitting during the first trimester and smoking fewer cigarettes at enrollment were also associated with achieving PPA at six months. DISCUSSION Racial/ethnic health disparities that have long been linked to a higher rate of maternal smoking persist even when the pregnant smoker enrolls in a smoking cessation program.
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Affiliation(s)
- Stacey D Wiles
- Health Promotion and Education, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Jerry W Lee
- Health Promotion and Education, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Anna Nelson
- Health Promotion and Education, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Anne Berit Petersen
- Nursing and Global Health, Schools of Nursing and Public Health, Transdisciplinary Tobacco Research Program, Loma Linda University, Loma Linda University Cancer Center, Loma Linda, CA, USA.
| | - Pramil N Singh
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, Loma Linda, CA, USA
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Higgins ST. Behavior change, health, and health disparities 2023: Contingency management for treating substance use disorders and promoting health in vulnerable populations. Prev Med 2023; 176:107746. [PMID: 37898183 DOI: 10.1016/j.ypmed.2023.107746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
This Special Issue (SI) of Preventive Medicine is the 10th in a series on behavior change, health, and health disparities. This issue focuses on Contingency Management (CM), a highly efficacious behavior-change intervention for substance use disorders (SUDs) and other behavioral health conditions wherein patients receive material incentives (e.g., vouchers exchangeable for retail items) contingent on objectively verified behavior change. Despite substantial support for its efficacy, CM remains largely unavailable in U.S. community SUD treatment facilities and other healthcare settings. This is especially concerning regarding stimulant use disorder for which CM is the only reliably efficacious intervention in controlled studies and yet is unavailable to the vast majority of those in need. This SI details recent promising developments in efforts to surmount longstanding implementation obstacles while also detailing other promising advances from meta-analyses and controlled trials examining CM's efficacy in treating other difficult-to-treat problems including smoking among pregnant women and mothers of young children as well among those as those experiencing homelessness and alcohol use disorder, the promise of digital CM, and a potential new application in promoting adherence with SUD medications.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, 1 South Prospect St., UHC, MS482 Burlington, VT 05401, USA.
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Higgins ST, Plucinski S, Orr E, Nighbor TD, Coleman SRM, Skelly J, DeSarno M, Bunn J. Randomized clinical trial examining financial incentives for smoking cessation among mothers of young children and possible impacts on child secondhand smoke exposure. Prev Med 2023; 176:107651. [PMID: 37527730 PMCID: PMC10825067 DOI: 10.1016/j.ypmed.2023.107651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/27/2023] [Accepted: 07/28/2023] [Indexed: 08/03/2023]
Abstract
This randomized clinical trial examined whether financial-incentives increase smoking cessation among mothers of young children and potential impacts on child secondhand-smoke exposure (SHSe). 198 women-child dyads were enrolled and assigned to one of three treatment conditions: best practices (BP, N = 68), best practices plus financial incentives (BP + FI, N = 63), or best practices, financial incentives, and nicotine replacement therapy (BP + FI + NRT, N = 67). The trial was completed in Vermont, USA between June 2015 and October 2020. BP entailed staff referral to the state tobacco quitline; financial incentives entailed mothers earning vouchers exchangeable for retail items for 12 weeks contingent on biochemically-verified smoking abstinence; NRT involved mothers receiving 10 weeks of free transdermal nicotine and nicotine lozenges/gum. Baseline, 6-, 12-, 24-, and 48-week assessments were conducted. Primary outcomes were maternal 7-day point-prevalence abstinence and child SHSe through the 24-week assessment with the 48-week assessment exploratory. Results were analyzed using mixed model repeated measures for categorical data. Odds of maternal abstinence were greater among mothers in BP + FI and BP + FI + NRT compared to BP at the 6- and 12-week assessments (ORs ≥ 7.30; 95% CIs: 2.35-22.71); only abstinence in BP + FI remained greater than BP at the 24-week assessment (OR = 2.95; 95% CIs: 1.06-8.25). Abstinence did not differ significantly between treatment conditions at the 48-week assesssment. There was a significant effect of treatment condition (F[2109] = 3.64, P = .029) on SHSe with levels in BP and BP + FI significantly below BP + FI + NRT (ts[109] ≥ -2.30, Ps ≤ 0.023). Financial incentives for smoking abstinence are efficacious for increasing maternal cessation but that alone was insufficient for reducing child SHSe. ClinicalTrials.gov:NCT05740098.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America; Department of Psychological Science, University of Vermont, United States of America.
| | - Shirley Plucinski
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America
| | - Eva Orr
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America
| | - Sulamunn R M Coleman
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America
| | - Joan Skelly
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Michael DeSarno
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Janice Bunn
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
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McCormack FC, Hopley RC, Boath EH, Parry SL, Roscoe SM, Stewart A, Birch VA. Exploring pregnant women's experiences of stopping smoking with an incentive scheme with 'enhanced' support: a qualitative study. Perspect Public Health 2023; 143:285-291. [PMID: 35787029 DOI: 10.1177/17579139221106842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM This study aims to understand pregnant women's experiences of smoking cessation with an incentive scheme in a deprived UK city. This is important because smoking cessation with pregnant women is one of the most crucial public health initiatives to promote, and is particularly challenging in deprived areas. While financial incentive schemes are controversial, there is a need to better understand pregnant women's experiences. The scheme combined quasi-financial incentives (shopping vouchers) for validated quits (carbon monoxide (CO) validated at < 10 ppm), enhanced support from smoking cessation advisors, the opportunity to identify a 'Significant Other Supporter' and nicotine replacement therapy. METHODS With the focus on understanding pregnant women's experiences, a qualitative design was adopted. Semi-structured interviews were completed with 12 pregnant women from the scheme, and the three advisors. All interviews were transcribed, and thematic analysis conducted. RESULTS Pregnant women reported various challenges to quitting, including long-established routines, and stress. Participants were aware of stigma around incentives but were all very positive about the scheme. The relationship with advisors was described as fundamental. The women valued their advice and support, while uptake of the 'Significant Other Supporter' appeared low. Participants viewed the CO monitoring as 'an incentive', while the vouchers were framed as a 'bonus'. Advisors perceived the vouchers as helping engage pregnant women and maintain quit status, and women appreciated the vouchers both as financial assistance and recognition of their accomplishments. CONCLUSION This study highlights the great value women placed on the support, advice and monitoring from specialist advisors. The distinction between vouchers as a welcomed bonus, rather than 'the incentive' to engage, is important. How smoking cessation and schemes to promote this are communicated to pregnant women and health professionals is important, particularly given the stigma and controversy involved.
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Affiliation(s)
- Fiona C McCormack
- Centre for Health and Development (CHAD), School of Health, Science and Wellbeing, Staffordshire University, Leek Road Campus, Stoke-on-Trent ST4 2DF, UK
| | - Rachel C Hopley
- Institute for Community Research and Development (ICRD), University of Wolverhampton, Wolverhampton, UK
| | - Elizabeth H Boath
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Sian L Parry
- Centre for Health and Development (CHAD), School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Suzie M Roscoe
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Antony Stewart
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
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Taylor AH, Thompson TP, Streeter A, Chynoweth J, Snowsill T, Ingram W, Ussher M, Aveyard P, Murray RL, Harris T, Green C, Horrell J, Callaghan L, Greaves CJ, Price L, Cartwright L, Wilks J, Campbell S, Preece D, Creanor S. Motivational support intervention to reduce smoking and increase physical activity in smokers not ready to quit: the TARS RCT. Health Technol Assess 2023; 27:1-277. [PMID: 37022933 PMCID: PMC10150295 DOI: 10.3310/kltg1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Background Physical activity can support smoking cessation for smokers wanting to quit, but there have been no studies on supporting smokers wanting only to reduce. More broadly, the effect of motivational support for such smokers is unclear. Objectives The objectives were to determine if motivational support to increase physical activity and reduce smoking for smokers not wanting to immediately quit helps reduce smoking and increase abstinence and physical activity, and to determine if this intervention is cost-effective. Design This was a multicentred, two-arm, parallel-group, randomised (1 : 1) controlled superiority trial with accompanying trial-based and model-based economic evaluations, and a process evaluation. Setting and participants Participants from health and other community settings in four English cities received either the intervention (n = 457) or usual support (n = 458). Intervention The intervention consisted of up to eight face-to-face or telephone behavioural support sessions to reduce smoking and increase physical activity. Main outcome measures The main outcome measures were carbon monoxide-verified 6- and 12-month floating prolonged abstinence (primary outcome), self-reported number of cigarettes smoked per day, number of quit attempts and carbon monoxide-verified abstinence at 3 and 9 months. Furthermore, self-reported (3 and 9 months) and accelerometer-recorded (3 months) physical activity data were gathered. Process items, intervention costs and cost-effectiveness were also assessed. Results The average age of the sample was 49.8 years, and participants were predominantly from areas with socioeconomic deprivation and were moderately heavy smokers. The intervention was delivered with good fidelity. Few participants achieved carbon monoxide-verified 6-month prolonged abstinence [nine (2.0%) in the intervention group and four (0.9%) in the control group; adjusted odds ratio 2.30 (95% confidence interval 0.70 to 7.56)] or 12-month prolonged abstinence [six (1.3%) in the intervention group and one (0.2%) in the control group; adjusted odds ratio 6.33 (95% confidence interval 0.76 to 53.10)]. At 3 months, the intervention participants smoked fewer cigarettes than the control participants (21.1 vs. 26.8 per day). Intervention participants were more likely to reduce cigarettes by ≥ 50% by 3 months [18.9% vs. 10.5%; adjusted odds ratio 1.98 (95% confidence interval 1.35 to 2.90] and 9 months [14.4% vs. 10.0%; adjusted odds ratio 1.52 (95% confidence interval 1.01 to 2.29)], and reported more moderate-to-vigorous physical activity at 3 months [adjusted weekly mean difference of 81.61 minutes (95% confidence interval 28.75 to 134.47 minutes)], but not at 9 months. Increased physical activity did not mediate intervention effects on smoking. The intervention positively influenced most smoking and physical activity beliefs, with some intervention effects mediating changes in smoking and physical activity outcomes. The average intervention cost was estimated to be £239.18 per person, with an overall additional cost of £173.50 (95% confidence interval -£353.82 to £513.77) when considering intervention and health-care costs. The 1.1% absolute between-group difference in carbon monoxide-verified 6-month prolonged abstinence provided a small gain in lifetime quality-adjusted life-years (0.006), and a minimal saving in lifetime health-care costs (net saving £236). Conclusions There was no evidence that behavioural support for smoking reduction and increased physical activity led to meaningful increases in prolonged abstinence among smokers with no immediate plans to quit smoking. The intervention is not cost-effective. Limitations Prolonged abstinence rates were much lower than expected, meaning that the trial was underpowered to provide confidence that the intervention doubled prolonged abstinence. Future work Further research should explore the effects of the present intervention to support smokers who want to reduce prior to quitting, and/or extend the support available for prolonged reduction and abstinence. Trial registration This trial is registered as ISRCTN47776579. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adrian H Taylor
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Tom P Thompson
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Adam Streeter
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Jade Chynoweth
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Tristan Snowsill
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Wendy Ingram
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tess Harris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Colin Green
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jane Horrell
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Lynne Callaghan
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Lisa Price
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Lucy Cartwright
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Jonny Wilks
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Sarah Campbell
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Dan Preece
- Public Health, Plymouth City Council, Plymouth, UK
| | - Siobhan Creanor
- Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
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Shepard DS, Slade EP, Nighbor TD, DeSarno MJ, Roemhildt ML, Williams RK, Higgins ST. Economic analysis of financial incentives for smoking cessation during pregnancy and postpartum. Prev Med 2022; 165:107079. [PMID: 35533885 PMCID: PMC11226006 DOI: 10.1016/j.ypmed.2022.107079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
Higgins and colleagues' recently-completed randomized controlled trial and pooled data with 4 related trials of smoking cessation in pregnant women in Vermont (USA) showed that abstinence-contingent financial incentives (FI) increased abstinence over control conditions from early pregnancy through 24-weeks postpartum. Control conditions were best practices (BP) alone in the recent trial and payments provided independent of smoking status (noncontingently) in the others. This paper reports economic analyses of abstinence-contingent FI. Merging trial results with maternal and infant healthcare costs from all Vermont Medicaid deliveries in 2019, we computed incremental cost-effectiveness ratios (ICERs) for quality-adjusted life years (QALYs) and compared them to established thresholds. The healthcare sector cost (±standard error) of adding FI to BP averaged $634.76 ± $531.61 per participant. Based on this trial, the increased probability per BP + FI participant of smoking abstinence at 24-weeks postpartum was 3.17%, the cost per additional abstinent woman was $20,043, the incremental health gain was 0.0270 ± 0.0412 QALYs, the ICER was $23,511/QALY gained, and the probabilities that BP + FI was very cost-effective (ICER≤$65,910) and cost-effective (ICER≤$100,000) were 67.9% and 71.0%, respectively. Based on the pooled trials, the corresponding values were even more favorable-8.89%, $7138, 0.0758 ± 0.0178 QALYs, $8371/QALY, 98.6% and 99.3%, respectively. Each dollar invested in abstinence-contingent FI over control smoking-cessation programs yielded $4.20 in economic benefits in the recent trial and $11.90 in the pooled trials (very favorable benefit-cost ratios). Medicaid and commercial insurers may wish to consider covering financial incentives for smoking abstinence as a cost-effective service for pregnant beneficiaries who smoke. Trial Registration: ClinicalTrials.gov identifier: NCT02210832.
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Affiliation(s)
- Donald S Shepard
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Heller School for Social Poilcy and Management, MS 035, Brandeis University, Waltham, MA 02454-9110 USA.
| | - Eric P Slade
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Johns Hopkins University School of Nursing, USA
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
| | - Michael J DeSarno
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Department of Medical Biostatistics, University of Vermont, USA
| | | | | | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA
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Braciszewski JM, Sala-Hamrick KJ, Zelenak L, Gootee J, Elsiss F, Ottolini J, Lanier A, Colby SM, Ahmedani BK. Reducing Smoking Cessation Disparities: Capacity for a Primary Care- and Technology-Based Approach Among Medicaid Recipients. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09925-1. [PMID: 36400987 DOI: 10.1007/s10880-022-09925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/19/2022]
Abstract
While cigarette use among U.S adults has recently decreased, vulnerable subgroups continue to smoke at high rates, including individuals receiving Medicaid insurance. These individuals have also experienced treatment access disparities, highlighting the need for approaches that leverage their strong desire to quit. We conducted interviews with 100 adult primary care patients receiving Medicaid who were current tobacco users about their use, openness to technology-based interventions, and readiness to change. Most (92%) reported current cigarette use and readiness to change averaged 6.98 out of 10 (SD = 2.82). Nearly all were open to completing an iPad-based tobacco screening (95%) and brief intervention (90%) at their next appointment, while 91% and 88% were willing to talk with their provider or a cessation counselor, respectively, about the subsequent results. Results persisted across age, sex, and race/ethnicity. Openness to technology-based interventions in this population provides support for future work that may ultimately reduce disparities.
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Jones M, Smith M, Lewis S, Parrott S, Coleman T. Investigating the cost-effectiveness of three cessation interventions on a national scale using the Economics of Smoking in Pregnancy (ESIP) decision analytical model. Addiction 2022; 117:2907-2917. [PMID: 35661312 PMCID: PMC9796630 DOI: 10.1111/add.15968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 05/20/2022] [Indexed: 01/01/2023]
Abstract
AIM To measure the cost-effectiveness of adding text message (TMB), exercise (EB) and abstinent-contingent financial incentive-based (CFIB) stop smoking interventions to standard smoking cessation support for pregnant women in England. DESIGN Modelling cost-effectiveness outcomes by separately adding three cessation interventions to standard cessation care offered to pregnant women in England. English National Health Service Stop Smoking Services (NHS SSS) statistics from 2019 to 2020 were used for estimating the base quit rate. Intervention effectiveness and cost data for interventions were taken from trial reports. Cost-effectiveness was derived using the economics of smoking in pregnancy (ESIP) model from a health service and personal social services perspective. Interventions were compared with each other as well as against standard cessation care. SETTING English NHS SSS. PARTICIPANTS/CASES A total of 13 799 pregnant women who accessed NHS SSS. Interventions and comparator; comparator: standard stop smoking support comprising behavioural intervention and an offer of nicotine replacement therapy (NRT). Three additive interventions were TMB, EB and CFIB. MEASUREMENTS Incremental cost-effectiveness ratios per quality-adjusted life-years gained for both mothers and offspring over their life-times; return on investment (ROI); and cost-effectiveness acceptability curves (CEACs). FINDINGS The addition of any of the interventions compared with standard care alone was preferred, but only significant for the addition of CFIB, with the CEAC suggesting an at least 90% chance of being favoured to standard care alone. When compared against each other CFIB appeared to yield the largest returns, but this was not significant. The estimated ROI for CFIB was £2 [95% confidence interval (CI) = £1-3] in health-care savings for every £1 spent by the NHS on the cessation intervention. CONCLUSIONS For a health system which currently provides behavioural support and an offer of nicotine replacement therapy as standard stop smoking support for pregnant women, the greatest economic gains would be provided by operating an abstinent-contingent financial incentives scheme alongside this.
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Affiliation(s)
- Matthew Jones
- NIHR School for Primary Care ResearchUniversity of NottinghamNottinghamUK
| | - Murray Smith
- Community and Health Research UnitUniversity of LincolnLincolnshireUK
| | - Sarah Lewis
- Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Steve Parrott
- Department of Health SciencesUniversity of YorkYorkUK
| | - Tim Coleman
- NIHR School for Primary Care ResearchUniversity of NottinghamNottinghamUK
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Tappin D, Sinclair L, Kee F, McFadden M, Robinson-Smith L, Mitchell A, Keding A, Watson J, Watson S, Dick A, Torgerson D, Hewitt C, McKell J, Hoddinott P, Harris FM, Boyd KA, McMeekin N, Ussher M, Bauld L. Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial. BMJ 2022; 379:e071522. [PMID: 36261162 PMCID: PMC9580214 DOI: 10.1136/bmj-2022-071522] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services. DESIGN Pragmatic, multicentre, single blinded, phase 3, randomised controlled trial (Cessation in Pregnancy Incentives Trial phase 3 (CPIT III)). SETTING Seven UK stop smoking services provided in primary and secondary care facilities in Scotland, Northern Ireland, and England. PARTICIPANTS 944 pregnant women (age ≥16 years) who self-reported as being smokers (at least one cigarette in the past week) when asked at first maternity visit, less than 24 weeks' gestation, and notified to the trial team by routine stop smoking services. INTERVENTIONS Participants in the control group were offered the standard stop smoking services, which includes the offer of counselling by specially trained workers using withdrawal orientated therapy and the offer of free nicotine replacement therapy. The intervention was the offer of usual support from the stop smoking services and the addition of up to £400 ($440; €455) of LoveToShop financial voucher incentives for engaging with current stop smoking services or to stop smoking, or both, during pregnancy. MAIN OUTCOME MEASURES Self-reported smoking cessation in late pregnancy (between 34 and 38 weeks' gestation) corroborated by saliva cotinine (and anabasine if using nicotine replacement products). Results were adjusted for age, smoking years, index of multiple deprivation, Fagerström score, before or after covid, and recruitment site. Secondary outcomes included point and continuous abstinence six months after expected date of delivery, engagement with stop smoking services, biochemically validated abstinence from smoking at four weeks after stop smoking date, birth weight of baby, cost effectiveness, generalisability documenting formats of stop smoking services, and acceptability to pregnant women and their carers. RESULTS From 9 January 2018 to 4 April 2020, of 4032 women screened by stop smoking services, 944 people were randomly assigned to the intervention group (n=471) or the control group (n=470). Three people asked for their data to be removed. 126 (27%) of 471 participants stopped smoking from the intervention group and 58 (12%) of 470 from the control group (adjusted odds ratio 2.78 (1.94 to 3.97) P<0.001). Serious adverse events were miscarriages and other expected pregnancy events requiring hospital admission; all serious adverse events were unrelated to the intervention. Most people who stopped smoking from both groups relapsed after their baby was born. CONCLUSIONS The offer of up to £400 of financial voucher incentives to stop smoking during pregnancy as an addition to current UK stop smoking services is highly effective. This bolt-on intervention supports new guidance from the UK National Institute for Health and Care Excellence, which includes the addition of financial incentives to support pregnant women to stop smoking. Continuing incentives to 12 months after birth is being examined to prevent relapse. TRIAL REGISTRATION ISRCTN Registry ISRCTN15236311.
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Affiliation(s)
- David Tappin
- Child Health, School of Medicine, Honorary Senior Research Fellow, University of Glasgow, UK
| | | | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Margaret McFadden
- National Health Service Lanarkshire Clinical Trials Unit, Airdrie, UK
| | | | | | - Ada Keding
- York Trials Unit, University of York, York, UK
| | | | - Sinead Watson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Alison Dick
- York Trials Unit, University of York, York, UK
| | | | | | - Jennifer McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Fiona M Harris
- School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- Population Health Research Institute, St George's, University of London, London, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
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12
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Saygın Avşar T, Jackson L, Barton P, Jones M, McLeod H. Towards optimum smoking cessation interventions during pregnancy: a household model to explore cost-effectiveness. Addiction 2022; 117:2707-2719. [PMID: 35603912 PMCID: PMC9541394 DOI: 10.1111/add.15955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/27/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Previous economic evaluations of smoking cessation interventions for pregnant women are limited to single components, which do not in isolation offer sufficient potential impact to address smoking cessation targets. To inform the development of more appropriate complex interventions, we (1) describe the development of the Economics of Smoking in Pregnancy: Household (ESIP.H) model for estimating the life-time cost-effectiveness of smoking cessation interventions aimed at pregnant women and (2) use a hypothetical case study to demonstrate how ESIP.H can be used to identify the characteristics of optimum smoking cessation interventions. METHODS The hypothetical intervention was based on current evidence relating to component elements, including financial incentives, partner smoking, intensive behaviour change support, cigarettes consumption and duration of support to 12 months post-partum. ESIP.H was developed to assess the life-time health and cost impacts of multi-component interventions compared with standard National Health Service (NHS) care in England. ESIP.H considers cigarette consumption, partner smoking and some health conditions (e.g. obesity) that were not included in previous models. The Markov model's parameters were estimated based on published literature, expert judgement and evidence-based assumptions. The hypothetical intervention was evaluated from an NHS perspective. RESULTS The hypothetical intervention was associated with an incremental gain in quitters (mother and partner) at 12 months postpartum of 249 [95% confidence interval (CI) = 195-304] per 1000 pregnant smokers. Over the long-term, it had an incremental negative cost of £193 (CI = -£779 to 344) and it improved health, with a 0.50 (CI = 0.36-0.69) increase in quality-adjusted life years (QALYs) for mothers, partners and offspring, with a 100% probability of being cost-effective. CONCLUSIONS The Economics of Smoking in Pregnancy: Household model for estimating cost-effectiveness of smoking cessation interventions aimed at pregnant women found that a hypothetical smoking cessation intervention would greatly extend reach, reduce smoking and be cost-effective.
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Affiliation(s)
- Tuba Saygın Avşar
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | - Louise Jackson
- Health Economics UnitUniversity of BirminghamBirminghamUK
| | - Pelham Barton
- Health Economics UnitUniversity of BirminghamBirminghamUK
| | - Matthew Jones
- Division of Primary CareUniversity of Nottingham, NottinghamUK
| | - Hugh McLeod
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK,The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
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13
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Inghels M, Kim HY, Mathenjwa T, Shahmanesh M, Seeley J, Wyke S, McGrath N, Sartorius B, Yapa HM, Dobra A, Bärnighausen T, Tanser F. Can a conditional financial incentive (CFI) reduce socio-demographic inequalities in home-based HIV testing uptake? A secondary analysis of the HITS clinical trial intervention in rural South Africa. Soc Sci Med 2022; 311:115305. [PMID: 36084520 DOI: 10.1016/j.socscimed.2022.115305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/04/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
In sub-Saharan Africa, home-based HIV testing interventions are designed to reach sub-populations with low access to HIV testing such as men, younger or less educated people. Combining these interventions with conditional financial incentives (CFI) has been shown to be effective to increase testing uptake. CFI are effective for one-off health behaviour change but whether they operate differentially on different socio-demographic groups is less clear. Using data from the HITS trial in South Africa, we investigated whether a CFI was able to reduce existing home-based HIV testing uptake inequalities observed by socio-demographic groups. Residents aged ≥15 years in the study area were assigned to an intervention arm (16 clusters) or a control arm (29 clusters). In the intervention arm, individuals received a food voucher (∼3.5 US dollars) if they accepted to take a home-based HIV test. Testing uptake differences were considered for socio-demographic (sex, age, education, employment status, marital status, household asset index) and geographical (urban/rural living area, distance from clinic) characteristics. Among the 37,028 residents, 24,793 (9290 men, 15,503 women) were included in the analysis. CFI increased significantly testing uptake among men (39.2% vs 25.2%, p < 0.001) and women (45.9% vs 32.0%, p < 0.001) with similar absolute increase between men and women. Uptake was higher amongst the youngest or least educated individuals, and amongst single (vs in union) or unemployed men. Absolute uptake increase was also significantly higher amongst these groups resulting in increasing socio-demographic differentials for home-based HIV testing uptake. However, because these groups are known to have less access to other public HIV testing services, CFI could reduce inequalities for HIV testing access in our specific context. Although CFI significantly increased home-based HIV testing uptake, it did not do so differentially by socio-demographic group. Future interventions using CFI should make sure that the intervention alone does not increase existing health inequities.
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Affiliation(s)
- Maxime Inghels
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France.
| | - Hae-Young Kim
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Department of Population Health, New York University School of Medicine, New York, NY, USA; KwaZulu-Natal Innovation and Sequencing Platform, KwaZulu-Natal, South Africa.
| | | | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, United Kingdom.
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
| | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, United Kingdom.
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - H Manisha Yapa
- Africa Health Research Institute, KwaZulu-Natal, South Africa; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | | | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa; Heidelberg Institute of Global Health (HIGH), Heidelberg University, 69120 Heidelberg, Germany.
| | - Frank Tanser
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
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14
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Verbeke E, Bogaerts A, Nuyts T, Crombag N, Luyten J. Cost-effectiveness of mental health interventions during and after pregnancy: A systematic review. Birth 2022; 49:364-402. [PMID: 35322898 DOI: 10.1111/birt.12623] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/29/2021] [Accepted: 02/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mental health problems during and after pregnancy such as depression, anxiety, post-traumatic stress disorder (PTSD), or addiction are common and can have lifelong implications for both parents and offspring. This review investigates the cost-effectiveness of interventions tackling these problems, assesses the methodological quality of included studies, and indicates suggestions for further research. METHODS Thirteen databases were searched for economic evaluations of interventions related to antenatal, perinatal, and postnatal mental health conditions, published between 2000 and September 2021, in high-income countries. RESULTS Thirty-nine studies met all inclusion criteria. Interventions considered were screening programs, pharmacological treatments, and various forms of psychosocial and psychological support. Six studies reported that the intervention was cost-saving. Eighteen were cost-effective and seven likely to be cost-effective. Only six studies included health outcomes for the child; one study considered paternal health. The time horizon for which costs and consequences were considered was for most evaluations limited to 1 year (n = 18) or 2 years (n = 11) postpartum. CONCLUSIONS Given the importance of the subject, a relatively low number of studies have investigated the cost-effectiveness of interventions tackling mental health problems during and after pregnancy. The scant evidence available suggests good overall value for money. Likely, cost-effectiveness is underestimated as costly long-term consequences on offspring are systematically excluded. No evidence was found for several frequently occurring conditions. Further research is required to obtain reliable, long-term effectiveness data and to address the methodological challenges related to measuring all relevant health outcomes for all parties affected.
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Affiliation(s)
- Evelyn Verbeke
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Annick Bogaerts
- Department of Development & Regeneration, Women & Child, REALIFE research group, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium.,Faculty of Health, University of Plymouth, Devon PL4 8AA, UK
| | - Tinne Nuyts
- Department of Development & Regeneration, Women & Child, REALIFE research group, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Neeltje Crombag
- Department of Development and Regeneration, Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Jeroen Luyten
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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15
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Pisinger C, Toxværd CG, Rasmussen M. Smoking Cessation Programs Are Less Effective in Smokers with Low Socioeconomic Status Even When Financial Incentives for Quitting Smoking Are Offered-A Community-Randomized Smoking Cessation Trial in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10879. [PMID: 36078595 PMCID: PMC9518409 DOI: 10.3390/ijerph191710879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Financial incentives offered to those who quit smoking have been found effective, also in persons with low socioeconomic status (SES), but no previous study has investigated who benefits most: smokers with low or high SES. In this community-randomized trial ("Richer without smoking"), three Danish municipalities were randomized to reward persons who were abstinent when attending the municipal smoking cessation program (FIMs) and three municipalities were randomized to spend the same amount on smoking cessation campaigns recruiting smokers to the smoking cessation program (CAMs). The municipalities each received approximately USD 16,000. An intention-to-treat approach was used in analyses. In regression analyses adjusted for individual- and municipal-level differences, we found that smokers with high SES living in FIMs had significantly higher proportion of validated long-term successful quitters (OR (95% CI): 2.59 (1.6-4.2)) than high-SES smokers living in CAM. Smokers with low SES, however, did not experience the same benefit of financial incentives as smokers with high SES. Neither the FIMs nor the CAMs succeeded in attracting more smokers with low SES during the intervention year 2018 than the year before. Our study showed that smokers with low SES did not experience the same benefit of financial incentives as smokers with high SES.
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Danish Heart Foundation, 1120 Copenhagen, Denmark
| | - Cecilie Goltermann Toxværd
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mette Rasmussen
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Bispebjerg & Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, 223 62 Lund, Sweden
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16
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Saroj SK, Bhardwaj T. Non-pharmacological interventions for tobacco cessation: A systematic review of existing practices and their effectiveness. Monaldi Arch Chest Dis 2022; 92. [PMID: 35347975 DOI: 10.4081/monaldi.2022.2229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Smoking tobacco is associated with lung cancer and other life-threatening diseases which requires serious action to curb it. Tobacco cessation interventions are available as pharmacological and non-pharmacological methods or a combination of both. The present review examines the effectiveness of the existing non-pharmacological tobacco cessation interventions and synthesizes the result for the future development of drug-free treatment in the community for tobacco cessation. The literature search was conducted in August 2020, using two electronic databases (PubMed and JSTOR), with search terms: ['tobacco cessation' OR 'smoking cessation'] AND ['intervention'] which included studies published during 2010 and 2020 (till 31st July 2020). All studies were limited to English language, human participants and excluded patients with comorbidities. A total of 2,114 publications were retrieved out of which 11 articles were reviewed. On the basis of intervention used in reviewed studies, we categorized them into seven categories: i. incentive-based intervention, ii. exercise based, iii. telephone-based proactive counselling, iv. mobile phone SMS (Short Message Service) based, v. smartphone app (application) based, vi. web-based intervention, vii. self-help material. Incentives were provided in most of the studies to maintain the retention rate and motivate the participants for completing follow-up. Non-pharmacological interventions for tobacco cessation include a combination of various elements. Our findings suggest that behavioural counselling is one of the most important elements of any non-pharmacological intervention. In addition to behaviour counselling, yoga and exercises along with self-help material, video and phone counselling may have higher efficacy. Thus, practicing non-pharmacological interventions may also increase the cessation rate and reduce the tobacco use burden.
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Affiliation(s)
| | - Tushti Bhardwaj
- Social Work Department, Dr. B. R. Ambedkar College, University of Delhi, New Delhi.
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17
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Pisinger C, Toxværd CG, Rasmussen M. Are financial incentives more effective than health campaigns to quit smoking? A community-randomised smoking cessation trial in Denmark. Prev Med 2022; 154:106865. [PMID: 34740676 DOI: 10.1016/j.ypmed.2021.106865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022]
Abstract
The aim of this community-randomised smoking cessation (SC) trial was to investigate both recruitment and SC-rates in three municipalities offering financial incentives (FIM) to smokers who stop smoking when attending a municipal SC-program and compare these with three municipalities investing in a campaign (CAM) that should encourage smokers to use the SC-program. Furthermore, in a non-randomised matched control design we investigated whether there was a difference in recruitment and SC-rates in the three FIM and the three CAM, comparing each with three matched control municipalities (MCM). Each municipality received approx. $16,000. The FIM rewarded persons who were abstinent when attending the municipal SC-program. The CAM spent the money on a campaign recruiting smokers to the SC-program. Two of three FIM were only partly active in recruiting smokers in the intervention year 2018. An intention-to-treat (ITT) approach was used in analyses. Complete case analyses and multiple imputation were used to address loss to follow-up. No difference in recruitment was found between the CAM and the FIM (p = 0.954), in adjusted analyses. In ITT analyses, FIM achieved significantly higher odds of validated abstinence from smoking at one-year follow-up (OR (95%CI): 1.63(1.1-2.4)), but not of self-reported continuous abstinence after six months than CAM. Compared with no intervention, campaigns increased the recruitment of smokers to the SC-program while financial incentives increased six months abstinence rates. In a randomised trial, no difference was demonstrated in the effect of financial incentives and campaigns to recruit smokers to a SC-program and financial incentives seemed superior to help smokers staying smoke-free for a year. TRIAL REGISTRATION: ClinicalTrials.Gov ID: NCT03849092.
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark; University of Copenhagen, Faculty of Health Sciences, Department of Public Health, Denmark; Danish Heart Foundation, Copenhagen, Denmark.
| | - Cecilie Goltermann Toxværd
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark.
| | - Mette Rasmussen
- WHO-CC, Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, The Capital Region of Denmark, Denmark; Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden.
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Affiliation(s)
- Leonieke J Breunis
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Jasper V Been
- Department of Paediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
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19
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Mundt MP, Fiore MC, Piper ME, Adsit RT, Kobinsky KH, Alaniz KM, Baker TB. Cost-effectiveness of stop smoking incentives for medicaid-enrolled pregnant women. Prev Med 2021; 153:106777. [PMID: 34450189 PMCID: PMC8595618 DOI: 10.1016/j.ypmed.2021.106777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/08/2021] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
Maternal smoking increases mortality and morbidity risks for both mother and infant. The First Breath Wisconsin study examined the cost-effectiveness of providing incentives to pregnant women who smoked to engage in stop smoking treatment. Participants (N = 1014) were Medicaid-enrolled pregnant women recruited from September 2012 to April 2015 through public health departments, private, and community health clinics in Wisconsin. The incentive group (n = 505) could receive $460 for completing pre-birth visits ($25 each), post-birth home visits ($40, $25, $25, $40 for 1-week, 2-month, 4-month and 6-month visits), monthly smoking cessation phone calls post-birth ($20 each), and biochemically-verified tobacco abstinence at 1-week ($40) and 6-months ($40) post-birth. The control group (n = 509) received up to $80 for 1-week ($40) and 6-month ($40) post-birth assessments. Intervention costs included incentive payments to participants, counselor and administrative staff time, and smoking cessation medications. Cost-effectiveness analysis calculated the incremental cost-effectiveness ratio (ICER) per one additional smoker who quit. The incentive group had higher 6-month post-birth biochemically-confirmed tobacco abstinence than the control group (14.7% vs. 9.2%). Incremental costs averaged $184 per participant for the incentive group compared to controls ($317 vs $133). The ICER of financial incentives was $3399 (95% CI $2228 to $8509) per additional woman who was tobacco abstinent at 6 months post-birth. The ICER was lower ($2518 vs $4760) for women who did not live with another smoker. This study shows use of financial incentives for stop smoking treatment is a cost-effective option for low-income pregnant women who smoke.
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Affiliation(s)
- Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Robert T Adsit
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Kathleen H Kobinsky
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Kristine M Alaniz
- Wisconsin Women's Health Foundation, Madison, WI, United States of America
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
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20
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Wilson ECF, Wastlund D, Moraitis AA, Smith GCS. Late Pregnancy Ultrasound to Screen for and Manage Potential Birth Complications in Nulliparous Women: A Cost-Effectiveness and Value of Information Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:513-521. [PMID: 33840429 DOI: 10.1016/j.jval.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Fetal growth restriction is a major risk factor for stillbirth. A routine late-pregnancy ultrasound scan could help detect this, allowing intervention to reduce the risk of stillbirth. Such a scan could also detect fetal presentation and predict macrosomia. A trial powered to detect stillbirth differences would be extremely large and expensive. OBJECTIVES It is therefore critical to know whether this would be a good investment of public research funds. The aim of this study is to estimate the cost-effectiveness of various late-pregnancy screening and management strategies based on current information and predict the return on investment from further research. METHODS Synthesis of current evidence structured into a decision model reporting expected costs, quality-adjusted life-years, and net benefit over 20 years and value-of-information analysis reporting predicted return on investment from future clinical trials. RESULTS Given a willingness to pay of £20 000 per quality-adjusted life-year gained, the most cost-effective strategy is a routine presentation-only scan for all women. Universal ultrasound screening for fetal size is unlikely to be cost-effective. Research exploring the cost implications of induction of labor has the greatest predicted return on investment. A randomized, controlled trial with an endpoint of stillbirth is extremely unlikely to be a value for money investment. CONCLUSION Given current value-for-money thresholds in the United Kingdom, the most cost-effective strategy is to offer all pregnant women a presentation-only scan in late pregnancy. A randomized, controlled trial of screening and intervention to reduce the risk of stillbirth following universal ultrasound to detect macrosomia or fetal growth restriction is unlikely to represent a value for money investment.
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Affiliation(s)
- Edward C F Wilson
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK; The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - David Wastlund
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Parexel Access Consulting, Parexel International, Stockholm, Sweden
| | - Alexandros A Moraitis
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Gordon C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
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Nystrand C, Gebreslassie M, Ssegonja R, Feldman I, Sampaio F. A systematic review of economic evaluations of public health interventions targeting alcohol, tobacco, illicit drug use and problematic gambling: Using a case study to assess transferability. Health Policy 2021; 125:54-74. [PMID: 33069504 DOI: 10.1016/j.healthpol.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 08/05/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022]
Abstract
AIMS To identify and assess the cost-effectiveness of public health interventions targeting the use of alcohol, illicit drugs and tobacco, as well as problematic gambling behavior (ANDTS), and consider whether the results from these evaluations are transferable to the Swedish setting. METHODS A systematic review of economic evaluations within the area of ANDTS was conducted including studies published between January 2000 and November 2018, identified through Medline, PsychINFO, Web of Science, the National Health Service Economic Evaluation Database and Health Technology Assessment. The quality of relevant studies and the possibilities of transferring results were assessed using criteria set out by the Swedish Agency for Health Technology Assessment. RESULTS Out of 54 relevant studies, 39 were of moderate to high quality and included in the review, however none for problematic gambling. Eighty-one out of a total of 91 interventions were cost-effective. The interventions largely focusing on taxed-based policies or screening and brief interventions. Thirteen of these studies were deemed to have high potential for transferability, with effect estimates considered relevant, and with good feasibility for implementation in Sweden. CONCLUSIONS Interventions targeting alcohol- and illicit-drug use and tobacco use are cost-effective approaches, and results may be transferred to the Swedish setting. Caution must be taken regarding cost estimates and the quality of the evidence which the studies are based upon.
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Affiliation(s)
- Camilla Nystrand
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden.
| | - Mihretab Gebreslassie
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden
| | - Richard Ssegonja
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, P.O Box 564, 751 22, Uppsala, Sweden
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Kurti AN, Tang K, Bolivar HA, Evemy C, Medina N, Skelly J, Nighbor T, Higgins ST. Smartphone-based financial incentives to promote smoking cessation during pregnancy: A pilot study. Prev Med 2020; 140:106201. [PMID: 32652133 PMCID: PMC7680385 DOI: 10.1016/j.ypmed.2020.106201] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/13/2020] [Accepted: 07/05/2020] [Indexed: 12/28/2022]
Abstract
Cigarette smoking during pregnancy increases risk for pregnancy complications, growth restriction, and other adverse health outcomes. The most effective intervention for reducing smoking during pregnancy is financial incentives contingent on biochemically-verified smoking abstinence. The present study examined the efficacy of a smartphone-based intervention whereby smoking monitoring and incentive delivery occurred remotely using a mobile app. If efficacious, this remote intervention would allow pregnant women residing in geographically remote areas to benefit from incentives-based cessation interventions. Sixty U.S. pregnant smokers were recruited between May 2018 to May 2019 via obstetrical clinics, Women, Infants, and Children (WIC) offices, and Facebook. Participants were assigned sequentially to one of two treatments: best practices alone (N = 30) or best practices plus financial incentives (N = 30). Outcomes were analyzed using repeated measures analysis based on generalized estimating equations (GEE). Seven-day point prevalence abstinence rates were greater in the incentives versus best practices arms early- (46.7% vs 20.0%, OR = 3.50, 95%CI = 1.11,11.02) and late-antepartum (36.7% vs 13.3%, OR = 3.76, 95%CI = 1.04,13.65), and four- (36.7% vs 10.0%, OR = 5.21, 95%CI = 1.28,21.24) and eight-weeks postpartum (40.0% vs 6.7%, OR = 9.33, 95%CI = 1.87,46.68), although not at the 12- (23.3% vs 10.0%, OR = 2.74, 95%CI = 0.63,11.82) or 24-week (20.0% vs 6.7%, OR = 3.50, 95%CI = 0.65,18.98) postpartum assessments likely due to this pilot study being underpowered for discerning differences at the later assessments, especially 24-weeks postpartum which was three months after treatment completion. These results support the efficacy of this remote, incentives-based intervention for pregnant smokers. Further research evaluating its efficacy and cost-effectiveness in a well-powered, randomized controlled trial appears warranted.
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Affiliation(s)
- Allison N Kurti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA.
| | - Katherine Tang
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Hypatia A Bolivar
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Carolyn Evemy
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA
| | - Norman Medina
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Joan Skelly
- Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Tyler Nighbor
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA
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Higgins ST, Slade EP, Shepard DS. Decreasing smoking during pregnancy: Potential economic benefit of reducing sudden unexpected infant death. Prev Med 2020; 140:106238. [PMID: 32818512 PMCID: PMC7429512 DOI: 10.1016/j.ypmed.2020.106238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022]
Abstract
Sudden Unexpected Infant Death (SUID) remains the leading cause of death among U.S. infants age 1-12 months. Extensive epidemiological evidence documents maternal prenatal cigarette smoking as a major risk factor for SUID, but leaves unclear whether quitting reduces risk. This Commentary draws attention to a report by Anderson et al. (Pediatrics. 2019, 143[4]) that represents a breakthrough on this question and uses their data on SUID risk reduction to delineate potential economic benefits. Using a five-year (2007-11) U.S. CDC Birth Cohort Linked Birth/Infant Death dataset, Anderson et al. demonstrated that compared to those who continued smoking, women who quit or reduced smoking by third trimester decreased the adjusted odds of SUID risk by 23% (95% CI, 13%-33%) and 12% (95% CI, 2%-21%), respectively. We applied these reductions to the U.S. Department of Health and Human Services' recommended value of a statistical life in 2020 ($10.1 million). Compared to continued smoking during pregnancy, the economic benefits per woman of quitting or reducing smoking are $4700 (95% CI $2700-$6800) and $2500 (95% CI, $400-$4300), respectively. While the U.S. obtained aggregate annual economic benefits of $0.58 (95% CI, 0.35-0.82) billion from pregnant women who quit or reduced smoking, it missed an additional $1.16 (95%CI 0.71-1.60) billion from the women who continued smoking. Delineating the health and economic impacts of decreasing smoking during pregnancy using large epidemiological studies like Anderson et al. is critically important for conducting meaningful economic analyses of the benefits-costs of developing more effective interventions for decreasing smoking during pregnancy.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Psychological Science, University of Vermont, United States of America.
| | - Eric P Slade
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Johns Hopkins University School of Nursing, United States of America
| | - Donald S Shepard
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Heller School for Social Policy and Management, Brandeis University, United States of America
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McMeekin N, Sinclair L, Bauld L, Tappin DM, Mitchell A, Boyd KA. A protocol for the economic evaluation of the smoking Cessation in Pregnancy Incentives Trial III (CPIT III). BMJ Open 2020; 10:e038827. [PMID: 33109658 PMCID: PMC7592273 DOI: 10.1136/bmjopen-2020-038827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Smoking results in an average 10-year loss of life, but smokers who permanently quit before age 40 can expect a near normal lifespan. Pregnancy poses a good opportunity to help women to stop; around 80% of women in the UK have a baby, most of whom are less than 40 years of age. Smoking prevalence during pregnancy is high: 17%-23% in the UK. Smoking during pregnancy causes low birth weight and increases the risk of premature birth. After birth, passive smoking is linked to sudden infant death syndrome, respiratory diseases and increased likelihood of taking up smoking. These risks impact the long-term health of the child with associated increase in health costs. Emerging evidence suggests that offering financial incentives to pregnant women to quit is highly cost effective.This protocol describes the economic evaluation of a multi-centre randomised controlled trial (Cessation in Pregnancy Incentives Trial III, CPIT III) designed to establish whether offering financial incentives, in addition to usual care, is effective and cost effective in helping pregnant women to quit. METHODS AND ANALYSIS The economic evaluation will identify, measure and value resource use and outcomes from CPIT III, comparing participants randomised to either usual care or usual care plus up to £400 financial incentives. Within-trial and long-term analyses will be conducted from a National Health Service and Personal Social Services perspective; the outcome for both analyses will be quality adjusted life-years measured using EQ-5D-5L. Patient level data collected during the trial will be used for the within-trial analysis, with an additional outcome of cotinine validated quit rates at 34-38 weeks gestation and 6 months postpartum. The long-term model will be informed by data from the trial and published literature. ETHICS AND DISSEMINATION TRIAL REGISTRATION NUMBER: ISRCTN15236311; Pre-results (https://doi.org/10.1186/ISRCTN15236311).
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Affiliation(s)
- Nicola McMeekin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lesley Sinclair
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Linda Bauld
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - David Michael Tappin
- Scottish Cot Death Trust, West Glasgow Ambulatory Care Hospital, University of Glasgow, Glasgow, UK
| | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Kurti AN. Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control. Exp Clin Psychopharmacol 2020; 28:501-516. [PMID: 31855002 PMCID: PMC8168442 DOI: 10.1037/pha0000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tobacco use has unique, adverse health consequences for reproductive-aged women, particularly should these women become pregnant. Thus, successful efforts to reduce tobacco use among this population have strong potential to improve public health and reduce health disparities. The present review examines contributions to reducing tobacco use among women of childbearing age spanning the domains of tobacco regulatory science and tobacco control from the passage of the Family Smoking Prevention and Tobacco Control Act in 2009 through September 2019. In the domain of tobacco regulatory science, such efforts include research conducted by various National Institutes of Health/Food and Drug Administration (FDA)-supported Tobacco Centers of Regulatory Science, epidemiological surveillance studies, as well as studies examining the potential impact of tobacco regulatory policies currently under consideration by the FDA (e.g., reduced nicotine content cigarettes, health warning labels). Tobacco control efforts within this same 10-year timeframe include developments in pharmacological and psychosocial approaches to promoting tobacco cessation, mHealth interventions, and tobacco control policy. Emerging issues pertinent to ongoing efforts to reduce tobacco use within the domains of both tobacco regulatory science and tobacco control are also reviewed, including e-cigarettes, comorbid health conditions, course of tobacco and other drugs of abuse, and obstacles to the dissemination and implementation of evidence-based treatment and policy. Although the past decade has seen numerous important contributions to reducing tobacco use among reproductive-aged women within both domains, existing obstacles must be surmounted to continue reducing tobacco use and protecting health among this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Vulimiri M, Bleser WK, Saunders RS, Madanay F, Moseley C, McGuire HF, Ubel PA, McKethan A, McClellan M, Wong CA. Engaging Beneficiaries In Medicaid Programs That Incentivize Health-Promoting Behaviors. Health Aff (Millwood) 2020; 38:431-439. [PMID: 30830831 DOI: 10.1377/hlthaff.2018.05427] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medicaid programs are increasingly adopting incentive programs to improve health behaviors among beneficiaries. There is limited evidence on what incentives are being offered to Medicaid beneficiaries, how programs are engaging beneficiaries, and how programs are evaluated. In 2017-18 we synthesized available information on these programs and interviewed eighty policy stakeholders to identify the rationale behind key program design decisions and stakeholders' recommendations for beneficiary engagement and program evaluation. Key underlying program rationales included improving the use of preventive services and promoting personal responsibility. Beneficiary engagement strategies emphasized meeting members where they are and offering prizes or services customized for certain groups. Stakeholders recommended collaborating with external evaluators to design and conduct robust evaluations of incentive programs. Finally, stakeholders recommended aligning beneficiary incentives with provider incentives and other payment reforms through the use of common meaningful measures to streamline program evaluation.
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Affiliation(s)
- Madhulika Vulimiri
- Madhulika Vulimiri is a senior Medicaid strategist at the North Carolina Department of Health and Human Services, in Raleigh, North Carolina. She was a master of public policy student in the Sanford School of Public Policy, Duke University, in Durham, North Carolina, at the time this work was conducted
| | - William K Bleser
- William K. Bleser is a research associate in the Duke-Margolis Center for Health Policy, Duke University, in Washington, D.C
| | - Robert S Saunders
- Robert S. Saunders is a research director in the Duke-Margolis Center for Health Policy, Duke University, in Washington, D.C
| | - Farrah Madanay
- Farrah Madanay is a PhD student in public policy in the Sanford School of Public Policy, Duke University, in Durham
| | - Connor Moseley
- Connor Moseley is a medical student in the Duke University School of Medicine in Durham
| | - Hunter F McGuire
- Hunter F. McGuire is a master of public health student in the Gillings School of Global Public Health, University of North Carolina at Chapel Hill. He was a research assistant in the Duke Clinical Research Institute in Durham at the time this work was conducted
| | - Peter A Ubel
- Peter A. Ubel is the Madge and Dennis T. McLawhorn Professor of Business, Public Policy, and Medicine at Duke University in Durham
| | - Aaron McKethan
- Aaron McKethan is an assistant professor in the Department of Population Health Sciences and a senior fellow in the Duke-Margolis Center for Health Policy, both in the Duke University School of Medicine in Durham
| | - Mark McClellan
- Mark McClellan is director of the Duke-Margolis Center for Health Policy in Washington, D.C., and the Robert J. Margolis Professor of Business, Medicine, and Policy at Duke University in Durham
| | - Charlene A Wong
- Charlene A. Wong ( ) is an assistant professor of pediatrics and public policy, and faculty in the Duke-Margolis Center for Health Policy and the Duke Clinical Research Institute, all at Duke University in Durham
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Peyronnet V, Koch A, Rault E, Perdriolle-Galet E, Bertholdt C. [N on-pharmacological management of smoking cessation during pregnancy- CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:590-603. [PMID: 32247854 DOI: 10.1016/j.gofs.2020.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess the benefit of non-pharmacological intervention promoting on smoking cessation, obstetric and neonatal outcomes, to offer pregnant women who smoke (PWS) optimal care. METHODS We searched Medline Database, Cochrane Library and consulted international guidelines. RESULTS "Counselling" involving globally all kind of non-pharmacological interventions has a benefit on smoking cessation (NP1) and a moderate benefit on birth weight and prematurity (NP2). The brief intervention seems ineffective on smoking cessation (NP2). The effects of motivational interviewing have not been demonstrated during pregnancy (NP2). Cognitive-behavioral interventions do not show superiority (NP2). Financial incentives have a benefit for smoking cessation and possibly for neonatal outcomes (NP1). Feedback interventions (Co tester) provide heterogeneous results (NP2). Self-help interventions (NP2) and health education (NP2) seem effective on smoking cessation. Hypnotherapy and acupuncture have been little or not studied in PWS. Moderate physical activity did not show a significant effect (NP2) on smoking cessation but seem to reduce craving for tobacco (NP3). CONCLUSIONS We recommend asking all PWS about their smoking consumption and detailing their smoking history, offering them different types of counselling according to their preferences and involving them multidisciplinary (grade A). The systematic use of feedback is not recommended (grade C) but experience suggests that the CO tester is important in establishing a therapeutic alliance (professional consensus). The use of self-help interventions (grade C) and health education (grade B) are recommended.
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Affiliation(s)
- V Peyronnet
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, Université de Paris, 178 rue des Renouillers, 92700 Colombes, France.
| | - A Koch
- Pôle de gynécologie-obstétrique, CHU de Strasbourg, 67000 Strasbourg, France
| | - E Rault
- Service d'obstétrique, hospices civils de Lyon, hôpital Femme-Mère-Enfant Lyon, 69500 Bron, France
| | - E Perdriolle-Galet
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 54035 Nancy, France
| | - C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandœuvre-les-Nancy, France
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van den Brand FA, Nagelhout GE, Winkens B, Chavannes NH, van Schayck OCP, Evers SMAA. Cost-effectiveness and cost-utility analysis of a work-place smoking cessation intervention with and without financial incentives. Addiction 2020; 115:534-545. [PMID: 31849138 PMCID: PMC7027826 DOI: 10.1111/add.14861] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/07/2019] [Accepted: 10/14/2019] [Indexed: 11/29/2022]
Abstract
AIMS To perform an economic evaluation of a work-place smoking cessation group training programme with incentives compared with a training programme without incentives. DESIGN A trial-based cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a societal perspective and an employer's perspective. SETTING Sixty-one companies in the Netherlands. PARTICIPANTS A total of 604 tobacco-smoking employees. INTERVENTION AND COMPARATOR A 7-week work-place smoking cessation group training programme. The intervention group earned gift vouchers of €350 for 12 months' continuous abstinence. The comparator group received no incentives. MEASUREMENTS Online questionnaires were administered to assess quality of life (EQ-5D-5 L) and resource use during the 14-month follow-up period (2-month training period plus 12-month abstinence period). For the CEA the primary outcome measure was carbon monoxide (CO)-validated continuous abstinence; for the CUA the primary outcome was quality-adjusted life years (QALY). Bootstrapping and sensitivity analyses were performed to account for uncertainty. Incremental cost-effectiveness ratio (ICER) tables were used to determine cost-effectiveness from a life-time perspective. FINDINGS Of the participants in the intervention group, 41.1% had quit smoking compared with 26.4% in the control group. From a societal perspective with a 14-month follow-up period, the ICER per quitter for an intervention with financial incentives compared with no incentives was €11 546. From an employer's perspective, the ICER was €5686. There was no significant difference in QALYs between the intervention and control group within the 14-month follow-up period. The intervention was dominated by the comparator in the primary analysis at a threshold of €20 000 per QALY. In the sensitivity analysis, these results were uncertain. A life-time perspective showed an ICER of €1249 (95% confidence interval = €850-2387) per QALY. CONCLUSIONS Financial incentives may be cost-effective in increasing quitting smoking, particularly from a life-time perspective.
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Affiliation(s)
| | - Gera E. Nagelhout
- Department of Family MedicineMaastricht University (CAPHRI)Maastrichtthe Netherlands,Department of Health PromotionMaastricht University (CAPHRI)Maastrichtthe Netherlands,IVO Research InstituteThe Haguethe Netherlands
| | - Bjorn Winkens
- Department of Methodology and StatisticsMaastricht University (CAPHRI)Maastrichtthe Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenthe Netherlands
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Sinclair L, McFadden M, Tilbrook H, Mitchell A, Keding A, Watson J, Bauld L, Kee F, Torgerson D, Hewitt C, McKell J, Hoddinott P, Harris FM, Uny I, Boyd K, McMeekin N, Ussher M, Tappin DM. The smoking cessation in pregnancy incentives trial (CPIT): study protocol for a phase III randomised controlled trial. Trials 2020; 21:183. [PMID: 32059684 PMCID: PMC7023794 DOI: 10.1186/s13063-019-4042-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/30/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Eighty per cent of UK women have at least one baby, making pregnancy an opportunity to help women stop smoking before their health is irreparably compromised. Smoking cessation during pregnancy helps protect infants from miscarriage, still birth, low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. UK national guidelines highlight lack of evidence for effectiveness of financial incentives to help pregnant smokers quit. This includes a research recommendation: within a UK context, are incentives an acceptable, effective and cost-effective way to help pregnant women who smoke to quit? METHODS The Cessation in Pregnancy Incentives Trial (CPIT) III is a pragmatic, 42-month, multi-centre, parallel-group, individually randomised controlled superiority trial of the effect on smoking status of adding to usual Stop Smoking Services (SSS) support, the offer of up to £400 of financial voucher incentives, compared with usual support alone, to quit smoking during pregnancy. Participants (n = 940) are pregnant smokers (age > 16 years, < 24 weeks pregnant, English speaking), who consent via telephone to take part and are willing to be followed-up in late pregnancy and 6 months after birth. The primary outcome is cotinine/anabasine-validated abstinence from smoking in late pregnancy. Secondary outcomes include engagement with SSS, quit rates at 4 weeks from agreed quit date and 6 months after birth, and birth weight. Outcomes will be analysed by intention to treat, and regression models will be used to compare treatment effects on outcomes. A meta-analysis will include data from the feasibility study in Glasgow. An economic evaluation will assess cost-effectiveness from a UK NHS perspective. Process evaluation using a case-study approach will identify opportunities to improve recruitment and learning for future implementation. Research questions include: what is the therapeutic efficacy of incentives; are incentives cost-effective; and what are the potential facilitators and barriers to implementing incentives in different parts of the UK? DISCUSSION This phase III trial in Scotland, England and Northern Ireland follows a successful phase II trial in Glasgow, UK. The participating sites have diverse SSS that represent most cessation services in the UK and serve demographically varied populations. If found to be acceptable and cost-effective, this trial could demonstrate that financial incentives are effective and transferable to most UK SSS for pregnant women. TRIAL REGISTRATION Current Controlled Trials, ISRCTN15236311. Registered on 9 October 2017.
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Affiliation(s)
- Lesley Sinclair
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Margaret McFadden
- Clinical R&D, Dykebar Hospital, Grahamstone Road, Paisley, PA2 7DE UK
| | - Helen Tilbrook
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Frank Kee
- Centre of Excellence for Public Health, Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
| | - Jennifer McKell
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
| | - Pat Hoddinott
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Fiona M. Harris
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
| | - Isabelle Uny
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
| | - Kathleen Boyd
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Nicola McMeekin
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Michael Ussher
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - David M. Tappin
- Scottish Cot Death Trust, West Glasgow Ambulatory Care Hospital, Glasgow University, 5th Floor, Glasgow, G3 8SJ UK
| | - for the CPIT III local research teams
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
- Clinical R&D, Dykebar Hospital, Grahamstone Road, Paisley, PA2 7DE UK
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Alcuin Research Resource Centre, Heslington, York, YO10 5DD UK
- Centre of Excellence for Public Health, Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
- NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA UK
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
- Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
- Scottish Cot Death Trust, West Glasgow Ambulatory Care Hospital, Glasgow University, 5th Floor, Glasgow, G3 8SJ UK
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Thao V, Nyman JA, Nelson DB, Joseph AM, Clothier B, Hammett PJ, Fu SS. Cost-effectiveness of population-level proactive tobacco cessation outreach among socio-economically disadvantaged smokers: evaluation of a randomized control trial. Addiction 2019; 114:2206-2216. [PMID: 31483549 PMCID: PMC6899559 DOI: 10.1111/add.14752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/31/2019] [Accepted: 07/09/2019] [Indexed: 11/27/2022]
Abstract
AIMS To estimate the cost-effectiveness at population-level of the OPT-IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low-income persons (e.g. Medicaid). DESIGN Cost-effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT-IN) randomized control trial. SETTING The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective. PARTICIPANTS Data were used from 2406 smokers who were randomized into the intervention or comparator groups. INTERVENTION AND COMPARATOR The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)-approved smoking cessation medications and the state's telephone quitline. MEASUREMENTS Smoking status, quality of life and health-care use at varying times, including at baseline and 1 year. FINDINGS The OPT-IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population-level, 6-month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life-time cost and generated 0.005 additional quality-adjusted life-years (QALYs), with an expected incremental cost-effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost-effective against a willingness-to-pay threshold of $50 000/QALY approximately 68% of the time. CONCLUSIONS Population-level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population-level quit rates and was cost-effective at various willingness-to-pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population-level proactive tobacco cessation outreach programs are judged to be highly cost-effective over the long term.
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Affiliation(s)
| | - John A. Nyman
- University of Minnesota School of Public HealthMinneapolisMNUSA
| | - David B. Nelson
- VA Health Services Research and Development Center for Care Delivery and Outcomes Research (CCDOR)MinneapolisMNUSA
- Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Anne M. Joseph
- Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Barbara Clothier
- VA Health Services Research and Development Center for Care Delivery and Outcomes Research (CCDOR)MinneapolisMNUSA
| | - Patrick J. Hammett
- University of Minnesota School of Public HealthMinneapolisMNUSA
- VA Health Services Research and Development Center for Care Delivery and Outcomes Research (CCDOR)MinneapolisMNUSA
| | - Steven S. Fu
- VA Health Services Research and Development Center for Care Delivery and Outcomes Research (CCDOR)MinneapolisMNUSA
- Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
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Polinski KJ, Wolfe R, Peterson A, Juhl A, Perraillon MC, Levinson AH, Crume TL. Impact of an incentive-based prenatal smoking cessation program for low-income women in Colorado. Public Health Nurs 2019; 37:39-49. [PMID: 31692104 DOI: 10.1111/phn.12682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/03/2019] [Accepted: 10/17/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess birth outcomes and cost-savings of an incentive-based prenatal smoking cessation program targeting low-income women in Colorado. DESIGN Prospective observational cohort with nonequivalent population control groups. SAMPLE Program participants (n = 2,231) linked to the birth certificate to ascertain birth outcomes compared to two reference populations from Pregnancy Risk Assessment Monitoring System (PRAMS) and Colorado live births based on the birth certificate. MEASUREMENTS Tobacco cessation metrics in the third trimester of pregnancy, neonatal low birth weight (<2,500 g), preterm birth (birth at <37 weeks gestation), neonatal intensive care unit (NICU) admission and maternal gestational hypertension. Cost-savings and return on investment (ROI) were projected using average Medicaid reimbursement. RESULTS Infants of mothers enrolled in the program had a lower risk of low birthweight (RR = 0.86; 95% CI = 0.75, 0.97), preterm birth (PTB) (RR = 0.76; 95% CI = 0.65, 0.88) and neonatal intensive care unit (NICU) admission (RR = 0.76; 95% CI = 0.66, 0.88) compared to the birth certificate population, corresponding to a ROI of $7.73 and an individual cost savings of $6,040. Compared to PRAMS, infants of enrolled mothers had a lower risk of PTB (RR = 0.72; 95% CI = 0.53, 0.99) and NICU admission (RR = 0.45; 95% CI = 0.32, 0.62), corresponding to an ROI of $2.79 and an individual cost savings of $2,182. CONCLUSIONS We found a reduction of adverse birth outcomes, and cost savings.
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Affiliation(s)
- Kristen J Polinski
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel Wolfe
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne Peterson
- Colorado Department of Public Health and Environment, Health Surveys and Evaluation Branch, Center for Health and Environmental Data, Denver, CO, USA
| | - Ashley Juhl
- Colorado Department of Public Health and Environment, Health Surveys and Evaluation Branch, Center for Health and Environmental Data, Denver, CO, USA
| | - Marcelo Coca Perraillon
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Arnold H Levinson
- Department of Community and Behavioral Health, Colorado School of Public Health and University of Colorado Cancer Center University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tessa L Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Alaniz K, Christiansen B, Sullivan T, Khalil L, Fiore MC. Addressing Postpartum Smoking Relapse Among Low-Income Women: A Randomized Control Trial. J Patient Cent Res Rev 2019; 6:233-242. [PMID: 31768402 PMCID: PMC6827840 DOI: 10.17294/2330-0698.1702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Smoking during pregnancy can have dire consequences for both the baby and mother. Low-income pregnant women smoke at particularly high rates. Among women who quit during pregnancy, postpartum relapse is high. This randomized control trial tested the effect of adding postpartum assistance to an existing smoking cessation program (First Breath) designed for low-income women. METHODS Of 185 study participants, 94 women were randomly assigned to the standard First Breath program (control) and 91 to an enhanced program. First Breath consisted of evidence-based smoking cessation counseling provided at every prenatal visit. The enhanced program included all First Breath services plus 4 in-home counseling visits (3 postpartum), 3 postpartum counseling calls, support to others in the home, and incentives (gift cards) totaling $100. The primary outcome was biochemically verified abstinence at 6 months postpartum. RESULTS Among the 98 women who completed the study, the abstinence rate among the intervention participants (n=41) was significantly greater than among the control participants (n=57) (36.6% vs 12.3%, respectively; P<0.01). Analyzed on an intent-to-treat basis, with those lost to follow-up assumed to be smoking, the abstinence rate among intervention subjects (n=91) was 16.5% vs 7.4% among control participants (n=94); P=0.07. CONCLUSIONS Extending smoking cessation interventions into the postpartum period may help address postpartum relapse.
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Affiliation(s)
| | - Bruce Christiansen
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Michael C. Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Robertson L, Gendall P, Hoek J, Marsh L, McGee R. Perceptions of Financial Incentives for Smoking Cessation: A Survey of Smokers in a Country With an Endgame Goal. Nicotine Tob Res 2019; 20:1481-1488. [PMID: 29253215 DOI: 10.1093/ntr/ntx268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/05/2017] [Indexed: 11/12/2022]
Abstract
Introduction Financial incentives can support smoking cessation, yet low acceptability may limit the wider implementation of such schemes. Few studies have examined how smokers view financial-incentive interventions aimed at reducing smoking prevalence. Methods We recruited a sample of 623 smokers from an internet panel to a survey assessing support for, and perceived effectiveness of, financial incentives for smoking cessation. We used descriptive statistics, plus logistic regression, to test associations between demographics and smoking, and support. We used qualitative content analysis to analyze open-ended responses to a question that invited respondents to comment on financial incentives. Results Financial incentives were supported by 38.4% of smokers; 42.2% did not support and 19.4% had no opinion. Support was higher among heavy (OR = 3.96, 95% CI = 2.39 to 6.58) and moderate smokers (OR = 1.68, 95% CI = 1.13 to 2.49), and those with a recent quit attempt (OR = 1.47, 95% CI = 1.04 to 2.07). Support was strongly associated with perceived effectiveness. A Government-funded reward-only scheme was seen as the most acceptable option (preferred by 26.6% of participants), followed by a Government-funded deposit-based scheme (20.6%); few respondents supported employer-funded schemes. Open-ended responses (n = 301) indicated three overarching themes expressing opposition to financial incentives: smokers' individual responsibility for quitting, concerns about abuse of an incentive scheme, and concerns about unfairness. Conclusion Even amongst those who would benefit from schemes designed to reward smokers for quitting, support for such schemes is muted, despite the evidence of their effectiveness. Media advocacy and health education could be used to increase the understanding of, and support for, financial incentives for smoking cessation. Implications Given the absolute effectiveness and cost effectiveness of financial-incentive schemes for smoking cessation amongst pregnant smokers and in workplaces, implementing such schemes at a national-level could help reduce overall smoking prevalence and contribute to endgame goals. Our study found that similar proportions of smokers supported and opposed financial-incentive schemes and suggests that much of the opposition was underpinned by information gaps, which could be addressed using education and media advocacy.
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Affiliation(s)
- Lindsay Robertson
- Cancer Society Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, South Island, New Zealand
| | - Philip Gendall
- Department of Marketing, University of Otago, South Island, New Zealand
| | - Janet Hoek
- Department of Marketing, University of Otago, South Island, New Zealand
| | - Louise Marsh
- Cancer Society Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, South Island, New Zealand
| | - Rob McGee
- Cancer Society Social & Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, South Island, New Zealand
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Higgins ST, Kurti AN, Davis DR. Voucher-Based Contingency Management is Efficacious but Underutilized in Treating Addictions. Perspect Behav Sci 2019; 42:501-524. [PMID: 31976447 PMCID: PMC6768932 DOI: 10.1007/s40614-019-00216-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The United States lags far behind other industrialized countries on major markers of population health. Population health experts identify unhealthy behavior patterns (e.g., cigarette smoking, other substance use disorders, physical inactivity and poor food choices, nonadherence with recommended medical regimens) as the largest contributor to the status quo. Because these risk behaviors are overrepresented in socioeconomically disadvantaged and other vulnerable populations, they also increase health disparities. Hence, identifying evidence-based strategies to promote and sustain health-related behavior change is critical to improving U.S. population health. In this report, we review research demonstrating the efficacy of voucher-based contingency management delivered alone or in combination with other interventions for treating substance use disorders and other health-related behavior problems. The efficacy supporting these interventions is robust and discernible at the level of controlled randomized clinical trials and meta-analyses. Unfortunately, these evidence-based interventions are being underutilized in routine clinical care for substance use disorders, although they are used broadly in private-sector wellness programs and international programs to reduce chronic poverty. This report reviews the evidence supporting the efficacy of voucher-based contingency management using projects developed at the University of Vermont as exemplars and discusses dissemination of the model to public and private sector efforts to improve individual and population health.
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Affiliation(s)
- Stephen T. Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry and Psychological Science, University of Vermont, Burlington, VT USA
| | - Allison N. Kurti
- Vermont Center on Behavior and Health, Department of Psychiatry and Psychological Science, University of Vermont, Burlington, VT USA
| | - Danielle R. Davis
- Vermont Center on Behavior and Health, Department of Psychiatry and Psychological Science, University of Vermont, Burlington, VT USA
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Hunter RF, Gough A, Murray JM, Tang J, Brennan SF, Chrzanowski-Smith OJ, Carlin A, Patterson C, Longo A, Hutchinson G, Prior L, Tully MA, French DP, Adams J, McIntosh E, Xin Y, Kee F. A loyalty scheme to encourage physical activity in office workers: a cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Increasing physical activity in the workplace can provide physical and mental health benefits for employees and economic benefits for the employer through reduced absenteeism and increased productivity. However, there is limited evidence on effective behaviour change interventions in workplace settings that led to maintained physical activity. This study aimed to address this gap and contribute to the evidence base for effective and cost-effective workplace interventions.
Objectives
To determine the effectiveness and cost-effectiveness of the Physical Activity Loyalty scheme, a multicomponent intervention based on concepts similar to those that underpin a high-street loyalty card, which was aimed at encouraging habitual physical activity behaviour and maintaining increases in mean number of steps per day.
Design
A cluster randomised controlled trial with an embedded economic evaluation, behavioural economic experiments, mediation analyses and process evaluation.
Setting
Office-based employees from public sector organisations in Belfast and Lisburn city centres in Northern Ireland.
Participants
A total of 853 participants [mean age 43.6 years (standard deviation 9.6 years); 71% of participants were female] were randomly allocated by cluster to either the intervention group or the (waiting list) control group.
Intervention
The 6-month intervention consisted of financial incentives (retail vouchers), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of the workplaces allowed participants to monitor their accumulated minutes of physical activity.
Main outcome measures
The primary outcome was mean number of steps per day recorded using a sealed pedometer (Yamax Digiwalker CW-701; Yamax, Tasley, UK) worn on the waist for 7 consecutive days and at 6 and 12 months post intervention. Secondary outcomes included health, mental well-being, quality of life, work absenteeism and presenteeism, and the use of health-care resources.
Results
The mean number of steps per day were significantly lower for the intervention group than the control group [6990 mean number of steps per day (standard deviation 3078) vs. 7576 mean number of steps per day (standard deviation 3345), respectively], with an adjusted mean difference of –336 steps (95% confidence interval –612 to –60 steps; p = 0.02) at 6 months post baseline, but not significantly lower at 12 months post baseline. There was a small but significant enhancement of mental well-being in the intervention group (difference between groups for the Warwick–Edinburgh Mental Wellbeing Scale of 1.34 points, 95% confidence interval 0.48 to 2.20 points), but not for the other secondary outcomes. An economic evaluation suggested that, overall, the scheme was not cost-effective compared with no intervention. The intervention was £25.85 (95% confidence interval –£29.89 to £81.60) more costly per participant than no intervention and had no effect on quality-adjusted life-years (incremental quality-adjusted life-years –0.0000891, 95% confidence interval –0.008 to 0.008).
Limitations
Significant restructuring of participating organisations during the study resulted in lower than anticipated recruitment and retention rates. Technical issues affected intervention fidelity.
Conclusions
Overall, assignment to the intervention group resulted in a small but significant decline in the mean pedometer-measured steps per day at 6 months relative to baseline, compared with the waiting list control group. The Physical Activity Loyalty scheme was deemed not to be cost-effective compared with no intervention, primarily because no additional quality-adjusted life-years were gained through the intervention. Research to better understand the mechanisms of physical activity behaviour change maintenance will help the design of future interventions.
Trial registration
Current Controlled Trials ISRCTN17975376.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth F Hunter
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Aisling Gough
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jennifer M Murray
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Jianjun Tang
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
| | - Sarah F Brennan
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | | | | | - Chris Patterson
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Alberto Longo
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - George Hutchinson
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Lindsay Prior
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - David P French
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Yiqiao Xin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- UKCRC Centre of Excellence for Public Health Research, Queen’s University Belfast, Belfast, UK
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Notley C, Gentry S, Livingstone‐Banks J, Bauld L, Perera R, Hartmann‐Boyce J. Incentives for smoking cessation. Cochrane Database Syst Rev 2019; 7:CD004307. [PMID: 31313293 PMCID: PMC6635501 DOI: 10.1002/14651858.cd004307.pub6] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Financial incentives, monetary or vouchers, are widely used in an attempt to precipitate, reinforce and sustain behaviour change, including smoking cessation. They have been used in workplaces, in clinics and hospitals, and within community programmes. OBJECTIVES To determine the long-term effect of incentives and contingency management programmes for smoking cessation. SEARCH METHODS For this update, we searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The most recent searches were conducted in July 2018. SELECTION CRITERIA We considered only randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed-population setting (e.g. community, work-, clinic- or institution-based), and also studies in pregnant smokers. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. The primary outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up (at least six months from the start of the intervention). In the trials of pregnant women we used abstinence measured at the longest follow-up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel-Haenzel random-effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster-randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations. MAIN RESULTS Thirty-three mixed-population studies met our inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty-four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long-term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease.Although not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self-deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self-deposits.We included 10 studies of 2571 pregnant women. We judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow-up (up to 24 weeks post-partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. AUTHORS' CONCLUSIONS Overall there is high-certainty evidence that incentives improve smoking cessation rates at long-term follow-up in mixed population studies. The effectiveness of incentives appears to be sustained even when the last follow-up occurs after the withdrawal of incentives. There is also moderate-certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post-partum. Current and future research might explore more precisely differences between trials offering low or high cash incentives and self-incentives (deposits), within a variety of smoking populations.
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Affiliation(s)
- Caitlin Notley
- University of East AngliaNorwich Medical SchoolNorwichUK
| | - Sarah Gentry
- University of East AngliaNorwich Medical SchoolNorwichUK
| | | | - Linda Bauld
- University of EdinburghUsher Institute, College of Medicine and Veterinary MedicineEdinburghUK
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
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Grant A, Morgan M, Mannay D, Gallagher D. Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (Capability, Opportunity, Motivation-Behaviour) model. BMC Pregnancy Childbirth 2019; 19:56. [PMID: 30744581 PMCID: PMC6371518 DOI: 10.1186/s12884-018-2156-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/17/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health behaviours during pregnancy and the early years of life have been proven to affect long term health, resulting in investment in interventions. However, interventions often have low levels of completion and limited effectiveness. Consequently, it is increasingly important for interventions to be based on both behaviour change theories and techniques, and the accounts of pregnant women. This study engaged with pregnant women from deprived communities, to understand their subjective experiences of health in pregnancy. METHODS The study adopted a women-centred ethos and recruited a purposive sample of ten pregnant women, who lived in deprived areas and were on low incomes. Participants engaged with three creative techniques of visual data production (timelines, collaging and dyad sandboxing), followed by elicitation interviews. One participant only engaged in the initial activity and interview, resulting in a total of 28 elicitation interviews. This in-depth qualitative approach was designed to enable a nuanced account of the participants' thoughts, everyday experiences and social relationships. Data were deductively coded for alcohol, smoking and infant feeding and then mapped to the COM-B model (Capability, Opportunity, Motivation - Behaviour). RESULTS Five participants had experience of smoking during pregnancy, four had consumed alcohol during pregnancy, and all participants, except one who had exclusively formula fed her child, disclosed a range of infant feeding experiences and intentions for their current pregnancies. Considerable variation was identified between the drivers of behaviour around infant feeding and that related to abstinence from tobacco and alcohol during pregnancy. Overall, knowledge and confidence (psychological capability), the role of partners (social opportunity) and support from services to overcome physical challenges (environmental opportunity) were reported to impact on (reflective) motivation, and thus women's behaviour. The role of the public in creating and reinforcing stigma (social opportunity) was also noted in relation to all three behaviours. CONCLUSIONS When designing new interventions to improve maternal health behaviours it is important to consider the accounts of pregnant women. Acknowledging pregnant women's subjective experiences and the challenges they face in negotiating acceptable forms of motherhood, can contribute to informed policy and practice, which can engage rather than isolate potential user groups.
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Affiliation(s)
- Aimee Grant
- Centre for Trials Research, Cardiff University Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK Wales
| | - Melanie Morgan
- Centre for Trials Research, Cardiff University Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK Wales
| | - Dawn Mannay
- School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT UK
| | - Dunla Gallagher
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast, UK Ireland
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Jones M, Smith M, Lewis S, Parrott S, Coleman T. A dynamic, modifiable model for estimating cost-effectiveness of smoking cessation interventions in pregnancy: application to an RCT of self-help delivered by text message. Addiction 2019; 114:353-365. [PMID: 30347119 PMCID: PMC6519118 DOI: 10.1111/add.14476] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/10/2018] [Accepted: 10/16/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Previous evaluations of smoking cessation interventions in pregnancy have several limitations. Our solution to these limitations is the Economics of Smoking in Pregnancy (ESIP) model, which estimates the life-time cost-effectiveness of smoking cessation interventions in pregnancy from a National Health Service (NHS) and personal social services perspective. We aim to (1) describe how ESIP has been constructed and (2) illustrate its use with trial data. METHODS ESIP links mothers' and offspring pregnancy outcomes to estimate the burdens of smoking-related disease they experience with different rates of smoking in pregnancy, both in pregnancy and throughout their life-times. Smoking rates are inputted by model users. ESIP then estimates the costs of treating disease burdens and also mothers' and offspring life-years and quality-adjusted life years (QALYs). By comparing costs incurred and healthy life following different smoking rates, ESIP estimates incremental cost-effectiveness and benefit-cost ratios for mothers or offspring or both combined. We illustrate ESIP use using data from a pragmatic randomized controlled trial that tested a smoking cessation intervention in pregnancy. RESULTS Throughout women's and offspring life-times, the intervention proved cheaper than usual care, having a negative incremental cost of £38.37 (interquartile range = £21.46-56.96) and it improved health, demonstrating a 0.04 increase in incremental QALYs for mothers and offspring, implying that it is 'dominant' over usual care. Benefit-cost ratios suggested that every £1 spent would generate a median of £14 (interquartile range = £8-20) in health-care savings. CONCLUSIONS Economics of Smoking in Pregnancy is the first economic model to link mothers' and infants' costs and benefits while reporting cost-effectiveness in readily-comparable units. Using ESIP with data from a trial which reported only short-term economic analysis showed that the intervention was very likely to be cost-effective in the longer term and to generate health-care savings.
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Affiliation(s)
- Matthew Jones
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Murray Smith
- Community and Health Research UnitUniversity of LincolnLincolnshireUK
| | - Sarah Lewis
- Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Steve Parrott
- Department of Health SciencesUniversity of YorkYorkUK
| | - Tim Coleman
- Division of Primary CareUniversity of NottinghamNottinghamUK
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Economic Impact of Financial Incentives and Mailing Nicotine Patches to Help Medicaid Smokers Quit Smoking: A Cost-Benefit Analysis. Am J Prev Med 2018; 55:S148-S158. [PMID: 30454669 DOI: 10.1016/j.amepre.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/05/2018] [Accepted: 08/02/2018] [Indexed: 01/12/2023]
Abstract
An RCT designed to increase Medicaid smokers' quitting success was conducted in California during 2012-2013. In the trial, alternative cessation treatment strategies were embedded in the state's ongoing quitline services. It found that modest financial incentives of up to $60 per participant and sending nicotine patches induced significantly higher cessation rates compared with usual care alone and usual care plus nicotine patches. Building upon that study, this study assessed potential population-level costs and benefits of integrating financial incentives and nicotine patches in a quitline setting for Medicaid smokers. A cost-benefit analysis was undertaken from the Medicaid program's perspective. The Cardiovascular Disease Policy Model was used to simulate future healthcare expenditures over a 10-year horizon for each treatment strategy for a study cohort of California Medicaid enrollees who were aged 35-64 years in 2014 (n=2,452,000). To simulate potential population-level benefits under each treatment strategy, each treatment was applied to all active smokers in the study cohort (n=478,300). Sensitivity analyses were conducted by varying key parameters, such as cessation costs, discount rate, relapse rates, and time horizon. Adding both financial incentives and nicotine patches to usual quitline care would result in $15 million net savings over 10 years, with a benefit-cost ratio of 1.30 compared with the usual care plus nicotine patches strategy. It would yield $44 million net savings, with a benefit-cost ratio of 1.90 compared with usual care alone. The strategy of providing financial incentives and mailing nicotine patches directly to Medicaid smokers who call the quitline is cost saving. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Wilson SM, Newins AR, Medenblik AM, Kimbrel NA, Dedert EA, Hicks TA, Neal LC, Beckham JC, Calhoun PS. Contingency Management Versus Psychotherapy for Prenatal Smoking Cessation: A Meta-Analysis of Randomized Controlled Trials. Womens Health Issues 2018; 28:514-523. [PMID: 30061033 PMCID: PMC6215492 DOI: 10.1016/j.whi.2018.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Prenatal smoking is the leading preventable cause of poor obstetric outcomes, yet treatment options are limited. Past reviews of prenatal smoking cessation have often grouped all counseling into a single category, which ignores the fact that psychotherapy is distinct from brief counseling. The objective of this study was to compare the effect sizes of two intensive interventions for prenatal smoking cessation: contingency management (i.e., financial incentives for abstinence) and psychotherapy. METHODS A systematic search for randomized controlled trials testing the efficacy of contingency management or psychotherapy was completed using PubMed, PsycINFO, Web of Science, the Cochrane Library, and EMBASE. Independent raters extracted data and assessed trials for risk of bias. Treatment effects were analyzed for three times points: late pregnancy, early postpartum, and late postpartum. RESULTS The search yielded 22 studies, and meta-analytic results indicated that interventions (compared with control groups) generally increased the odds of abstinence. Moderator analyses indicated that intervention type (contingency management vs. psychotherapy) accounted for variability in effect sizes. When comparing treatment type, effects of contingency management interventions were significantly greater than those of psychotherapeutic interventions. Although psychotherapy did not affect smoking abstinence, contingency management interventions had significant treatment effects at all three time points. CONCLUSIONS Contingency management seems to be a safe and efficacious prenatal smoking cessation treatment. Although psychotherapy alone did not show an effect on prenatal smoking abstinence, future research may seek to combine this approach with contingency management to promote prenatal smoking cessation.
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Affiliation(s)
- Sarah M Wilson
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; VA Center for Health Services Research in Primary Care, Durham, North Carolina.
| | | | | | - Nathan A Kimbrel
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Eric A Dedert
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | | | - Lydia C Neal
- Duke University School of Medicine, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Jean C Beckham
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Patrick S Calhoun
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; VA Center for Health Services Research in Primary Care, Durham, North Carolina
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Emery JL, Coleman T, Sutton S, Cooper S, Leonardi-Bee J, Jones M, Naughton F. Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy When Advertised on the Internet (MiQuit): Observational Study. J Med Internet Res 2018; 20:e146. [PMID: 29674308 PMCID: PMC5934538 DOI: 10.2196/jmir.8525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 11/13/2022] Open
Abstract
Background Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message–based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown. Objective The objective of this study was to explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (“MiQuit”) when advertised on the internet. Methods Links to a website providing MiQuit initiation information (texting a short code) were advertised on a cost-per-click basis on 2 websites (Google Search and Facebook; £1000 budget each) and free of charge within smoking-in-pregnancy webpages on 2 noncommercial websites (National Childbirth Trust and NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for 1 and 3 months, respectively. We recorded the number of times adverts were shown and clicked on, the number of MiQuit initiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per additional quitter. Results With equal capped budgets, there were 812 and 1889 advert clicks to the MiQuit website from Google (search-based) and Facebook (banner) adverts, respectively. MiQuit was initiated by 5.2% (42/812) of those clicking via Google (95% CI 3.9%-6.9%) and 2.22% (42/1889) of those clicking via Facebook (95% CI 1.65%-2.99%). Adverts on noncommercial webpages generated 53 clicks over 6 months, with 9 initiations (9/53, 17%; 95% CI 9%-30%). For the commercial websites combined, mean cost per initiation was £24.73; estimated cost per additional quitter, including text delivery costs, was £735.86 (95% CI £227.66-£5223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation 5 weeks, interquartile range 10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation 16 weeks, interquartile range 14 weeks). Conclusions Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support and may generate uptake at a faster rate than noncommercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers.
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Affiliation(s)
- Joanne L Emery
- Behavioral Science Group, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Tim Coleman
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stephen Sutton
- Behavioral Science Group, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Matthew Jones
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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Bauld L, Graham H, Sinclair L, Flemming K, Naughton F, Ford A, McKell J, McCaughan D, Hopewell S, Angus K, Eadie D, Tappin D. Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study. Health Technol Assess 2018; 21:1-158. [PMID: 28661375 DOI: 10.3310/hta21360] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although many women stop smoking in pregnancy, others continue, causing harm to maternal and child health. Smoking behaviour is influenced by many factors, including the role of women's significant others (SOs) and support from health-care professionals (HPs). OBJECTIVES To enhance understanding of the barriers to, and facilitators of, smoking cessation and the feasibility and acceptability of interventions to reach and support pregnant women to stop smoking. DESIGN Four parts: (1) a description of interventions in the UK for smoking cessation in pregnancy; (2) three systematic reviews (syntheses) of qualitative research of women's, SOs' and HPs' views of smoking in pregnancy using meta-ethnography (interpretative approach for combining findings); (3) semistructured interviews with pregnant women, SOs and HPs, guided by the social-ecological framework (conceptualises behaviour as an outcome of individuals' interactions with environment); and (4) identification of new/improved interventions for future testing. SETTING Studies in reviews conducted in high-income countries. Qualitative research was conducted from October 2013 to December 2014 in two mixed urban/rural study sites: area A (Scotland) and area B (England). PARTICIPANTS Thirty-eight studies (1100 pregnant women) in 42 papers, nine studies (150 partners) in 14 papers and eight studies described in nine papers (190 HPs) included in reviews. Forty-one interviews with pregnant women, 32 interviews with pregnant women's SOs and 28 individual/group interviews with 48 HPs were conducted. MAIN OUTCOME MEASURES The perceived barriers to, and facilitators of, smoking cessation in pregnancy and the identification of potential new/modified interventions. RESULTS Syntheses identified smoking-related perceptions and experiences for pregnant women and SOs that were fluid and context dependent with the capacity to help or hinder smoking cessation. Themes were analysed in accordance with the social-ecological framework levels. From the analysis of the interviews, the themes that were central to cessation in pregnancy at an individual level, and that reflected the findings from the reviews, were perception of risk to baby, self-efficacy, influence of close relationships and smoking as a way of coping with stress. Overall, pregnant smokers were faced with more barriers than facilitators. At an interpersonal level, partners' emotional and practical support, willingness to change smoking behaviour and role of smoking within relationships were important. Across the review and interviews of HPs, education to enhance knowledge and confidence in delivering information about smoking in pregnancy and the centrality of the client relationship, protection of which could be a factor in downplaying risks, were important. HPs acknowledged that they could best assist by providing support and understanding, and access to effective interventions, including an opt-out referral pathway to Stop Smoking Services, routine carbon monoxide screening, behavioural support and access to pharmacotherapy. Additional themes at community, organisational and societal levels were also identified. LIMITATIONS Limitations include a design grounded in qualitative studies, difficulties recruiting SOs, and local service configurations and recruitment processes that potentially skewed the sample. CONCLUSIONS Perceptions and experiences of barriers to and facilitators of smoking cessation in pregnancy are fluid and context dependent. Effective interventions for smoking cessation in pregnancy should take account of the interplay between the individual, interpersonal and environmental aspects of women's lives. FUTURE WORK Research focus: removing barriers to support, improving HPs' capacity to offer accurate advice, and exploration of weight concerns and relapse prevention. Interventions focus: financial incentives, self-help and social network interventions. STUDY REGISTRATION This study is registered as PROSPERO CRD42013004170. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Linda Bauld
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Lesley Sinclair
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK.,Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - Allison Ford
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Jennifer McKell
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | | | - Sarah Hopewell
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - Kathryn Angus
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Douglas Eadie
- Institute for Social Marketing, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - David Tappin
- Child Health, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
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Hand DJ, Ellis JD, Carr MM, Abatemarco DJ, Ledgerwood DM. Contingency management interventions for tobacco and other substance use disorders in pregnancy. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:907-921. [PMID: 28639813 PMCID: PMC5714659 DOI: 10.1037/adb0000291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Contingency management (CM) is an effective intervention for reducing use of licit and illicit substances in a variety of populations. Pregnant women are a vulnerable population with much to gain from effective interventions for substance use disorders, and for whom CM interventions may be especially well-suited. We reviewed the literature on CM interventions among pregnant women with tobacco and other substance use disorders with 3 aims: (a) describe the effectiveness of CM for reducing use of tobacco and other substances during pregnancy, (b) describe the effects of CM interventions on infant outcomes, and (c) identify needs for future research on CM in pregnancy. Our search strategy revealed 27 primary studies of CM in pregnancy. CM was effective in the majority of studies targeting nicotine abstinence, and results were mixed in studies targeting illicit substances. A variety of methodologies were used within the relatively small number of studies making it difficult to identify underlying mechanisms. Also, very few studies reported maternal and infant outcomes, and significant effects of CM were only apparent when secondary analyses pooled data from multiple studies. Furthermore, there is extremely limited data on the cost effectiveness of CM interventions in pregnancy. Future research should address these 3 areas to better determine the ultimate value of CM as an efficacious treatment for pregnant women with substance use disorders. (PsycINFO Database Record
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Affiliation(s)
- Dennis J Hand
- Department of Obstetrics and Gynecology, Thomas Jefferson University
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Wayne State University
| | - Meagan M Carr
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Wayne State University
| | | | - David M Ledgerwood
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Wayne State University
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Naughton F, Cooper S, Foster K, Emery J, Leonardi‐Bee J, Sutton S, Jones M, Ussher M, Whitemore R, Leighton M, Montgomery A, Parrott S, Coleman T. Large multi-centre pilot randomized controlled trial testing a low-cost, tailored, self-help smoking cessation text message intervention for pregnant smokers (MiQuit). Addiction 2017; 112:1238-1249. [PMID: 28239919 PMCID: PMC5488183 DOI: 10.1111/add.13802] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/15/2016] [Accepted: 02/22/2017] [Indexed: 02/05/2023]
Abstract
AIMS To estimate the effectiveness of pregnancy smoking cessation support delivered by short message service (SMS) text message and key parameters needed to plan a definitive trial. DESIGN Multi-centre, parallel-group, single-blinded, individual randomized controlled trial. SETTING Sixteen antenatal clinics in England. PARTICIPANTS Four hundred and seven participants were randomized to the intervention (n = 203) or usual care (n = 204). Eligible women were < 25 weeks gestation, smoked at least one daily cigarette (> 5 pre-pregnancy), were able to receive and understand English SMS texts and were not already using text-based cessation support. INTERVENTION All participants received a smoking cessation leaflet; intervention participants also received a 12-week programme of individually tailored, automated, interactive, self-help smoking cessation text messages (MiQuit). OUTCOME MEASUREMENTS Seven smoking outcomes, including validated continuous abstinence from 4 weeks post-randomization until 36 weeks gestation, design parameters for a future trial and cost-per-quitter. FINDINGS Using the validated, continuous abstinence outcome, 5.4% (11 of 203) of MiQuit participants were abstinent versus 2.0% (four of 204) of usual care participants [odds ratio (OR) = 2.7, 95% confidence interval (CI) = 0.93-9.35]. The Bayes factor for this outcome was 2.23. Completeness of follow-up at 36 weeks gestation was similar in both groups; provision of self-report smoking data was 64% (MiQuit) and 65% (usual care) and abstinence validation rates were 56% (MiQuit) and 61% (usual care). The incremental cost-per-quitter was £133.53 (95% CI = -£395.78 to 843.62). CONCLUSIONS There was some evidence, although not conclusive, that a text-messaging programme may increase cessation rates in pregnant smokers when provided alongside routine NHS cessation care.
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Affiliation(s)
- Felix Naughton
- School of Health SciencesUniversity of East AngliaNorwichUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Sue Cooper
- Division of Primary CareUniversity of NottinghamNottinghamUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Katharine Foster
- Division of Primary CareUniversity of NottinghamNottinghamUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Joanne Emery
- Behavioural Science GroupUniversity of CambridgeCambridgeUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Jo Leonardi‐Bee
- Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Stephen Sutton
- Behavioural Science GroupUniversity of CambridgeCambridgeUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Matthew Jones
- Division of Primary CareUniversity of NottinghamNottinghamUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Michael Ussher
- Population Health Research InstituteSt George's University of LondonLondonUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Rachel Whitemore
- Division of Primary CareUniversity of NottinghamNottinghamUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Matthew Leighton
- Nottingham Clinical Trials UnitUniversity of NottinghamNottinghamUK
| | - Alan Montgomery
- Nottingham Clinical Trials UnitUniversity of NottinghamNottinghamUK
| | - Steve Parrott
- Department of Health SciencesUniversity of YorkYorkUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Tim Coleman
- Division of Primary CareUniversity of NottinghamNottinghamUK,UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
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Chamberlain C, O'Mara‐Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2017; 2:CD001055. [PMID: 28196405 PMCID: PMC6472671 DOI: 10.1002/14651858.cd001055.pub5] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. MAIN RESULTS The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.
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Affiliation(s)
- Catherine Chamberlain
- La Trobe UniversityJudith Lumley Centre251 Faraday StreetMelbourneVicAustralia3000
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - Alison O'Mara‐Eves
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jessie Porter
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
| | - Tim Coleman
- University of NottinghamDivision of Primary CareD1411, Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | - Susan M Perlen
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
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Higgins ST, Davis DR, Kurti AN. Financial Incentives for Reducing Smoking and Promoting Other Health-Related Behavior Change in Vulnerable Populations. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2372732216683518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Substantial reductions in U.S. cigarette smoking and associated chronic diseases over the past 50 years have benefited health. Unfortunately, those reductions have distributed unevenly throughout the population. Smoking remains prevalent and even increasing among certain vulnerable populations: economically disadvantaged groups, those with other substance-use disorders or mental illness, certain ethnic and racial minorities, and gender and sexual minorities. Moreover, other unhealthy behavior patterns (physical inactivity, unhealthy food choices, risky sexual behavior, poor adherence to medical preventive regimens) and associated chronic diseases are also overrepresented in many of these same populations. Disparities in unhealthy behavior patterns contribute to health disparities and escalating health care costs, underscoring the need for more effective behavior-change strategies. This report reviews research on the efficacy of financial incentives for reducing smoking in vulnerable populations, while also touching on applications of that behavior-change strategy for promoting other health-related behavior changes in vulnerable populations.
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van den Brand FA, Nagelhout GE, Winkens B, Evers SMAA, Kotz D, Chavannes NH, van Schayck CP. The effect of financial incentives on top of behavioral support on quit rates in tobacco smoking employees: study protocol of a cluster-randomized trial. BMC Public Health 2016; 16:1056. [PMID: 27716132 PMCID: PMC5053183 DOI: 10.1186/s12889-016-3729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stimulating successful tobacco cessation among employees has multiple benefits. Employees who quit tobacco are healthier, more productive, less absent from work, and longer employable than employees who continue to use tobacco. Despite the evidence for these benefits of tobacco cessation, a successful method to stimulate employees to quit tobacco is lacking. The aim of this study is to evaluate whether adding a financial incentive to behavioral support (compared with no additional incentive) is effective and cost-effective in increasing abstinence rates in tobacco smoking employees participating in a smoking cessation group training. METHODS/DESIGN In this cluster-randomized trial employees in the intervention and control group both participate in a smoking cessation group training consisting of seven weekly counseling sessions of ninety minutes each. In addition to the training, employees in the intervention group receive a voucher as an incentive for being abstinent from smoking at the end of the training (€50), after three months (€50), after six months (€50), and after one year (€200). The control group does not receive any incentive. The primary outcome is carbon monoxide validated 12-month continuous abstinence from smoking (Russel's standard). Additionally, an economic evaluation is performed from a societal and an employer perspective. DISCUSSION The present paper describes the methods and design of this cluster-randomized trial in detail. We hypothesize that the financial incentive for abstinence in the form of vouchers increases abstinence rates over and above the group training. The results of this study can provide important recommendations for enhancement of employee tobacco cessation. TRIAL REGISTRATION Dutch Trial Register: NTR5657 . First received 27-01-2016.
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Affiliation(s)
- F. A. van den Brand
- Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - G. E. Nagelhout
- Department of Health Promotion/Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - B. Winkens
- Department of Methodology and Statistics, Maastricht University, P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - S. M. A. A. Evers
- Department of Health Services Research, Maastricht University (CAPHRI), Duboisdomein 30, 6229 GT Maastricht, Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluations, Utrecht, Netherlands
| | - D. Kotz
- Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
- Department of Institute of General Practice, Heinrich-Heine University, P.O. Box 101007, 40001 Düsseldorf, Germany
| | - N. H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD Leiden, Netherlands
| | - C. P. van Schayck
- Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
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Giles EL, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study. BMC Public Health 2016; 16:989. [PMID: 27633661 PMCID: PMC5025536 DOI: 10.1186/s12889-016-3646-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/06/2016] [Indexed: 12/02/2022] Open
Abstract
Background Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. Methods We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. Results Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential ‘gaming’, and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI – including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for ‘gaming the system’. Secondly, a tension between participants’ own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants’ personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool. Conclusions There are aspects of design that influence acceptability of financial incentive interventions to public health policymakers. However, it is not clear that even interventions designed to maximise acceptability would be acceptable enough to be recommended for implementation. Further work may be required to help policymakers understand the potential responses of other stakeholder groups to financial incentive interventions.
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Affiliation(s)
- Emma L Giles
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,School of Health & Social Care, Health & Social Care Institute, University of Teesside, Middlesbrough, UK
| | - Falko F Sniehotta
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jean Adams
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK. .,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
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Representativeness of the participants in the smoking Cessation in Pregnancy Incentives Trial (CPIT): a cross-sectional study. Trials 2016; 17:426. [PMID: 27565625 PMCID: PMC5002204 DOI: 10.1186/s13063-016-1552-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background The limited representativeness of trial samples may restrict external validity. The aim of this study was to ascertain the representativeness of the population enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), a therapeutic exploratory study to examine the effectiveness of financial incentives for smoking cessation during pregnancy. Methods CPIT participants (n = 492) were compared with all self-reported smokers at maternity booking who did not participate in the trial (n = 1982). Both groups were drawn from the National Health Service (NHS) Greater Glasgow and Clyde area over a 1-year trial enrolment period. Variables used for comparison were age, area-based deprivation index, body mass index, gestation, and carbon monoxide (CO) breath test level. Chi-square and Mann-Whitney U tests were used to compare groups. Results From January to December 2012, 2474/13,945 (17.7 %) women, who booked for maternity care, self-reported as current smokers (at least one cigarette in the last week). Seven hundred and fifty-two were ineligible for trial participation because of a CO breath test level of less than 7 parts per million (ppm) used as a biochemical cut-off to corroborate self-report of current smoking. At telephone consent 301 could not be contacted, 11 had miscarried, 16 did not give consent and 3 opted out after randomisation, leaving 492 participants for analysis. There were no differences in demographic or clinical characteristics between trial participants, and self-reported smokers not enrolled in the trial in terms of CO breath test (as a measure of smoking level for those with a CO level of 7 ppm or higher), material deprivation (using an area-based measure), maternal age and maternal body mass index. Gestation at booking was statistically significantly lower for participants. Conclusions To ensure that all trial participants were smokers, biochemical validation excluded self-reported smokers with a CO level of less than 7 ppm from taking part in the trial, which excluded 30 % of self-reported smokers who were ‘lighter’ smokers. The efficacy of financial incentives would not have been likely to decrease if ‘lighter’ smokers had been included in the trial population. Trial participants were slightly earlier in their pregnancy at maternity booking, but this difference would not clinically affect the provision of financial incentives if provided routinely. Overall, the trial population was representative of all self-reported smokers with regard to available routinely collected data. Appropriate comparison of trial and target populations, with detailed reporting of exclusion criteria would contribute to the understanding of the wider applicability of trial results. Trial registration Current Controlled Trials ISRCTN87508788. Registered/Assigned on 1 September 2011.
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Berlin N, Goldzahl L, Jusot F, Berlin I. Protocol for study of financial incentives for smoking cessation in pregnancy (FISCP): randomised, multicentre study. BMJ Open 2016; 6:e011669. [PMID: 27466239 PMCID: PMC4964243 DOI: 10.1136/bmjopen-2016-011669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Maternal smoking during pregnancy is associated with adverse perinatal and postnatal health outcomes. The efficacy of nicotine replacement therapies in helping pregnant smokers to quit is not clearly demonstrated; therefore new interventions should be proposed and assessed. Financial incentives rewarding abstinence from tobacco smoking is one of the promising options. OBJECTIVE To assess the efficacy of financial incentives on smoking abstinence among French pregnant smokers. PARTICIPANTS pregnant smokers aged ≥18 years, smoking at least five manufactured or three roll-your-own cigarettes per day, and pregnant for <18 weeks of amenorrhoea (WA). SETTING participants will be recruited, included and followed-up at monthly face-to-face visits in 16 maternity wards in France. INTERVENTIONS participants will be randomised to a control or an intervention group. After a predefined quit date, participants in the control group will receive €20 vouchers at the completion of each visit but no financial incentive for smoking abstinence. Participants in the intervention group will be rewarded for their abstinence by vouchers on top of the €20 show-up fee. The amount of reward for abstinence will increase as a function of duration of abstinence to stimulate longer periods of abstinence. MAIN OUTCOME MEASURE complete abstinence from quit date to the last predelivery visit. SECONDARY OUTCOME MEASURES point prevalence abstinence, time to relapse to smoking, birth weight, fetal growth restriction, preterm birth. Main data analysis: outcomes will be analysed on an intention-to-treat (ITT) basis. The ITT population is defined as all randomised smoking pregnant women. ETHICS AND DISSEMINATION The research protocol was approved by the ethics committee (Comité de Protection des Personnes, CPP) of the Pitié-Salpêtrière Hospital on 15 May 2015, and Amendment No 1 was approved on 13 July 2015. Results will be presented at scientific meetings and published. TRIAL REGISTRATION NUMBER NCT02606227; Pre-results.
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Affiliation(s)
- Noémi Berlin
- University of Edinburgh, School of Economics, Edinburgh, UK
| | | | | | - Ivan Berlin
- Department of Pharmacology, Hôpital Pitié-Salpêtrière, Faculté de médecine-Université P. & M. Curie, INSERM U1178, Paris, France
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