Glasgow cash-incentive trial led to smoking quit rates doubling

More than a quarter (26.8%) of pregnant women given a Love2Shop voucher had quit smoking by the end of their pregnancy compared with 12.3% of those who only received the standard services.

Most of the pregnant women who quit from both groups relapsed after their baby was born.

Research is now ongoing to find out if extending financial voucher incentives for 12 months after the birth would result in mothers stopping smoking "permanently".

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Professor David Tappin, who led the study, said there was now enough evidence to show that financial incentives could help the NHS improve health and save money in the longer term.

He said he was surprised by the attitude of some doctors who questioned if the NHS could afford to give out cash or vouchers when it might be more beneficial for their health than costlier drugs.

He said the approach had also been shown to be effective in weight loss and could also be used in other areas of healthcare such as screening in areas where uptake is low.

He said: "Financial incentives started for non-attendance at clinics, that has been trialled and shown to be effective.

"The other areas which could be employed are in weight loss to get people to engage with services.

"That's another promising area.

"This research showed that in the long term, the actual costs of this[financial incentives] were less for the NHS.

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He added:"I've been doing this for ten years and what surprises me is how the general public find it difficult to think that giving money to help people change their lifestyle - they find that more difficult than giving them a drug that probably doesn't do them as good as stopping smoking or losing weight

"It's not just the general public, many doctors say to me 'there's not enough money in the NHS so why are you giving it to people.

"Even with evidence people still have a huge aversion this type of intervention.

"That's why this type of research is important -to show that it actually works."

He said another trial in Glasgow led to a 50% reduction in smoking using a much smaller financial incentive.

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Maternal smoking is responsible for  7% of childhood hospital admissions for respiratory infection, 20% of infant deaths and 30% of babies born underweight. 

In Scotland, between 1995 and 2019 self-reported smoking among pregnant women declined from 30.5% to 14.6% – a decline that was matched with falls in the rates of miscarriages and small births.

However, despite progress in helping pregnant women to stop smoking, there is evidence that engagement with smoking cessation services is variable. 

Interventions using financial incentives were initially piloted in the US and led to the development of this phase three trial in the UK.

The study took place at seven different sites across Scotland, England and Northern Ireland and confirmed results through nicotine saliva testing. 

The participants were tested for smoking status between week 34 and week 38 of pregnancy. 

The study was carried out jointly with the University of Edinburgh, Queen's University Belfast, and the Universities of Stirling and York and is published in The BMJ.

Professor Linda Bauld, joint principal investigator, from the University of Edinburgh, said: " Most women who smoke in pregnancy in the UK are from lower income groups, who will be most affected by the cost of living crisis, and these vouchers will have helped them both make a quit attempt and stay smokefree through pregnancy. 

"This kind of intervention is about prevention, spending up front to avoid much more serious and costly health problems for the baby and the Mum if she continues to smoke.”