目的:提供经济奖励对怀孕期间戒烟有效。我们测试了维持产后停止的经济激励措施的有效性,将12个月和3个月的激励措施与彼此以及与常规护理(UC)进行比较。
方法:这项研究是一项务实的研究,多中心,涉及四个英国人的三臂随机对照试验,国家卫生服务,停止吸烟服务。共有462名产后妇女(年龄≥16岁)参加,在怀孕期间停止吸烟的经济奖励,验证为在怀孕结束或产后早期戒烟。
方法:干预措施包括(i)UC;(ii)UC加上向参与者提供的高达60英镑的财务凭证奖励和向可选的重要其他支持者提供的60英镑,产后3个月以上,视有效的禁欲而定(“3个月激励”);或(iii)UC加“3个月激励”加180英镑向参与者提供9个月产后的优惠券,视禁欲而定(“12个月奖励”)。
方法:主要结果:产后1年生化验证禁欲。要调整测试具有相同精度的组之间的所有比较,P<0.017是显著性所必需的。
结果:产后3个月自我报告和验证的禁欲;产后1年自我报告的禁欲。
结果:主要结果确定:禁欲为39.6%(63/159)12个月的奖励,21.4%(33/154)3个月激励和28.2%(42/149)UC。调整后的赔率比[95%置信区间(CI)]=12个月与3个月激励OR=2.41(95%CI=1.46-3.96),P=0.001;12个月与UC1.67(1.04-2.70)相比,P=0.035;3个月与UC0.69(0.41-1.17)相比,P=0.174。贝叶斯因素表明,对于12个月与3个月的激励措施以及12个月与UC的激励措施,有很好的证据表明替代假设,与UC相比,3个月以来,存在原假设的良好证据。
结论:这项随机对照试验提供了微弱的证据,表明与常规护理相比,超过12个月的高达300英镑的优惠券激励措施对维持产后戒烟有效。有充分的证据表明,12个月的激励措施优于仅3个月的激励措施,没有证据表明相对于常规治疗有效。
OBJECTIVE: Offering financial incentives is effective for smoking cessation during pregnancy. We tested the effectiveness of financial incentives for maintaining postpartum cessation, comparing 12-month and 3-month incentives with each other and with usual care (UC).
METHODS: This
study was a pragmatic, multi-centre, three-arm randomized controlled
trial involving four English, National Health Service, stop smoking services. A total of 462 postpartum women (aged ≥ 16 years) took part, who stopped smoking during pregnancy with financial incentives, validated as abstinent from smoking at end of pregnancy or early postpartum.
METHODS: Interventions comprised (i) UC; (ii) UC plus up to £60 of financial voucher incentives offered to participants and £60 offered to an optional significant-other supporter, over 3 months postpartum, contingent upon validated abstinence (\'3-month incentives\'); or (iii) UC plus \'3-month incentives\' plus £180 of vouchers offered to participants over 9 months postpartum, contingent upon abstinence (\'12-month incentives\').
METHODS: Primary outcome: biochemically validated abstinence at 1 year postpartum. To adjust for testing all comparisons between groups with equal precision, P < 0.017 was necessary for significance.
RESULTS: self-reported and validated abstinence at 3 months postpartum; self-reported abstinence at 1 year postpartum.
RESULTS: Primary outcome ascertainment: abstinence was 39.6% (63/159) 12 months incentives, 21.4% (33/154) 3 months incentives and 28.2% (42/149) UC. Adjusted odds ratios [95% confidence interval (CI)] = 12-month versus 3-month incentives OR = 2.41 (95% CI = 1.46-3.96), P = 0.001; 12 months versus UC 1.67 (1.04-2.70), P = 0.035; 3 months versus UC 0.69 (0.41-1.17), P = 0.174. Bayes factors indicated that for 12-month versus 3-month incentives and 12 months versus UC there was good evidence for the alternative hypothesis, and for 3 months versus UC there was good evidence for the null hypothesis.
CONCLUSIONS: This randomized controlled
trial provides weak evidence that up to £300 of voucher incentives over 12 months is effective for maintaining smoking abstinence postpartum compared with usual care. There was good evidence that 12-month incentives are superior to those over only 3 months, for which there was no evidence of effectiveness relative to usual care.