Impact of an incentive-based prenatal smoking cessation program for low-income women in Colorado.
Kristen J Polinski, Rachel Wolfe, Anne Peterson and 4 others
PMID 31692104WHAT IT FOUND
Low-income women in a smoking cessation program with diaper vouchers had lower risks of preterm birth and NICU admissions than unenrolled smokers.
However, the study cannot separate the effect of the vouchers from the counseling, nor rule out that enrolled women were simply more motivated to quit.
Key findings
01Participants in the program had a 24% lower risk of preterm birth and a 24% lower risk of NICU admission compared to a birth certificate reference group.
02The program cost $781 per person, with estimated annual state savings between $1.4 million and $4.1 million.
03It is impossible to distinguish the effects of the diaper voucher incentive from the motivational interviewing components on birth outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational study, not a randomized trial, so it cannot prove the program caused the better outcomes. Women who enrolled might have been more motivated to quit than those who refused, but data on refusals was not available. Smoking status in the program group was verified by breath test before birth, while reference groups relied on self-report after birth, which can be biased. The study could not separate the impact of the diaper vouchers from the impact of the counseling sessions. The analysis assumed reference groups received no additional cessation care, which may not be true.
Declared interests
Research supported by N.I.H. and other government agencies. No specific financial conflicts of interest with commercial entities were reported in the provided text.
The easy way to misread this
Do not conclude that diaper vouchers alone caused the reduction in preterm birth and NICU admissions. The study design cannot separate the effect of the vouchers from the motivational interviewing, and enrolled women may have been more motivated to quit than the comparison groups.