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Leading midwife questions cash incentives for smoking in pregnancy

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Cash incentives aid quit attempts Cash incentives shouldnt be the answer for pregnany smokers

Offering vouchers to pregnant smokers to encourage them to quit is not an 'ideal' way to discourage smoking in pregnancy, a leading midwife has said.

Janet Fyle, professional policy advisor at the RCM, said: 'We have said before that incentivising public health behaviour change through monetary reward is not ideal. Alternative ways of stopping smoking in pregnancy also need attention, such as pre-conception care for those planning to get pregnant and midwives providing continuous antenatal advice.'

Ms Fyle made the comment after a study of 612 women in Glasgow found that giving cash vouchers to pregnant women made them more likely to quit smoking during pregnancy.

The study, published in the BMJ, evaluated self-reported smokers who were at least 16 years old, less than 24 weeks pregnant, and fluent English speakers. Of this group, 306 were offered up to £400 of shopping vouchers to quit smoking, as well as using normal NHS stop smoking services. The study found that 22.5 per cent of women offered the vouchers successfully stopped smoking, compared to 8.6 per cent of women who only used the NHS stop smoking services.

The cash incentives were given at different stages of the quitting process. The first £50 was given when the participant attended a face-to-face appointment and set a quit date. Another £50 was given if low levels of exhaled carbon monoxide were found four weeks after the quit date, and a further £100 was provided for continued abstinence of exhaled carbon monoxide, 12 weeks after the quit date. The final £200 voucher was provided for confirmed abstinence at 34 to 38 weeks into the pregnancy.

There was also evidence that monetised incentives might not be as effective as suggested by the study, due to participants relapsing or being untruthful about their quit attempt. The study's authors said: 'We found some evidence of women being untruthful about their smoking status over the telephone. Eighteen participants who self reported as quitters to the helpline subsequently reported as current smokers when arranging a confirmation visit with the research nurse. Fifty three others were never available to the research nurses to collect confirmatory samples.'

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