There’s Something Disturbing About It, But Paying Pregnant Women To Quit Smoking Works

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shutterstock_147565130__1398189719_142.196.167.223Providing economically disadvantage women with financial incentives appears to help them quit smoking, according to a new study published this month in Preventive Medicine. The findings show providing financial incentives more than doubled smoking abstinence rates during pregnancy and increased fetal growth. We could argue endlessly about the reasons why this is troubling, but one fact remains – it works.

Financial Incentives Help Pregnant Women Quit SmokingSmoking during pregnancy – particularly among economically-disadvantaged women – leads to a host of poor pregnancy outcomes, including miscarriage, preterm birth, SIDS, and additional adverse effects later in life. Without a formal treatment intervention, women in this population continue to smoke, and their babies suffer. Vermont Center on Behavior and Health Director Stephen Higgins, Ph.D., and colleagues, have developed an effective behavioral economic approach that offers women financial incentives for quitting.

This group’s study showed that offering financial incentives more than doubled smoking abstinence rates during pregnancy. A similar study done in the UK earlier this year (not on pregnant women) showed that offering as little as $6 was enough to make people 50 percent more likely to quit. I have to admit this confuses me a little. If one is a regular smoker, there are built-in financial benefits to quitting, aren’t there? There certainly are in New York City, where a pack of cigarettes can cost up to $13.

In an ideal world, the health of a baby would be enough incentive to make a mother quit – but that is just not realistic I guess. The monetary incentive plan studied in the UK also offered people rewards for things like eating healthy and exercising – which all worked to varying degrees.

I have no problem with low-income mothers being given financial incentives to quit if it means they will and give birth to healthier babies. Not only is a healthy baby just a better outcome all-around, but taxpayers will ultimately save money because there presumably won’t be as many medical bills to pay if there are not as many sick babies, right? The only problem I can see here is that someone who would be driven by a monetary reward but not simply by concern over the health of their child will probably just take up smoking again when the baby is born, and that is not a healthy environment for a child either. Then what happens? How long do we “pay” people to make healthy decisions for themselves and their families?

(photo: wong yu liang/ Shutterstock)


  1. Ursi

    April 22, 2014 at 4:28 pm

    Makes no sense to me that his would work, for the reason you already mentioned, as by quitting you are technically being paid not to smoke anyway (those cartons sure add up), but hey I guess people are weird that way.

    I just don’t think paying people to do better for their kids is a solution to anything. And I do have a lot of compassion for smokers. Once you’re hooked it’s a hard habit to quit and I gotta be honest I wouldn’t look twice at a pregnant woman smoking. It’s not something *I* would do pregnant, but everyone’s got their issues. Long term, though, this solves nothing.

    I’d also wager that smoking cigarettes will be illegal in the US within my lifetime. Not sure I’m on board with that but it seems to be the way we’re going.

    • jane

      April 22, 2014 at 4:50 pm

      But it is a solution to something; people smoking while pregnant, which is a problem in and of itself. Yes, some of these women might go back to smoking after the pregnancy, but I’d bet that many don’t. And it might also be a “foot-in-the-door” for other healthy behaviors. If women are willing to quit smoking, they might also be willing to try a breastfeeding class. If they’re willing to try a breastfeeding class, they might also be willing to try a nutrition class. If they’re willing to try a nutrition class, they might be willing to try a parenting class, etc etc.

      And before I get accused of being classist, let me say that LOTS of upper income people probably need these classes as well. But we know that there are things that we can do to help break the cycle of poverty – healthy kids means moms and dads miss less work, eating well is correlated with better grades in school, parenting classes means less reliance on corporal punishment (which leads to physical aggression in kids which leads to school suspensions, etc).

      Sure, we want people to make the right choices on their own, but if we can jump into the cycle and see if we make positive change for just $6/day, I’m all for it.

  2. TwentiSomething Mom

    April 22, 2014 at 4:42 pm

    It does make perfect sense because they aren’t prohibiting smoking or criminalizing the behavior. I hope it does work.

  3. Kay_Sue

    April 22, 2014 at 5:06 pm

    It’s true that there are built in financial incentives to quitting smoking, but there are different prevailing attitudes on money, which are really affected by one’s socioeconomic background. They could see saving it as different than receiving it. That’s a philosophical distinction that could be explored, based on existing research that shows differences in how money, financial stability and such are perceived by different classes.

    There’s also a more concrete possibility, I guess you could say. When you are talking modifying behavior using a reward, it’s like being on a teeter totter. At one end, you have all the reasons your person doing the behavior you don’t want wants to keep doing that behavior. At the other end, you add reward. If the reward isn’t enough, it won’t encourage the behavior you want to start or stop–the teeter totter won’t shift. Increase the reward, and you’ll eventually hit a tipping point where the rewards you offer overcome the objections raised by the other person. It could be as simple as the cost savings and monetary incentive combined are enough that a person would be more open to quitting smoking, especially if they believe that it will only be temporary (many women do start again after pregnancy–my mom did all three times she was pregnant, and eventually stopped because she wanted to).

    Overall, it’s interesting. I doubt any program would take off in the US though, because even if you can show that it benefits everyone, there’s such a stigma regarding “entitlement” programs.

    • Butt Trophy Recipient

      April 22, 2014 at 6:17 pm

      Don’t forget the fraud and abuse.

      Suddenly, everyone’s gonna be a smoker that quits!

  4. Greta Young

    April 22, 2014 at 6:02 pm

    Monetary incentives work, plain and simple. They work particularly well from a loss aversion standpoint — think “I’ll give you your $500 bonus upfront, but if your performance declines, you’ll be paying it back come mid-year review. But whether or not such incentives are enough to alter behavior over the long-term remains an area of concern.

    Several recent studies (out of Cambridge and Columbia, I think — and featured in NYTimes a while back) involved recruiting crack and meth users, then offering them a choice between a hit of their drug of choice or $5. The experimenters adjusted the dose — when the dose was high, people opted for the drugs. When the dose was low, they took the cash. When the money was upped to $20, they all chose the cash — despite the fact they knew they woudln’t be receiving the cash until long after the study’s conclusion. So it’s not like they were going out and immediately spending $20 on crack as soon as they left the research facility. The conclusions they drew were that these highly addictive drugs might not be as irresistable to addicts as we make them out to be — IF a more appealing alternative is provided.

    How much of a person’s addiction is strictly chemical, and how much of it is a product of environmental influence? If I live in an area where a pack of camels is my only relief, albeiit a short-lived one, from the everyday stress of poverty/abuse/illiteracy/food insecurity/lack of gainful employment/etc, I’ll probably light up again — unless the monetary incentive is enough to get me out of there.

  5. Rachel Sea

    April 22, 2014 at 6:08 pm

    If it works, I’m for it. The social cost of supporting babies born with smoking-related complications is probably higher than the cost of paying mothers to quit. Some will surely pick it back up, but some won’t, and either way their babies will have gotten a better start.

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