英国格拉斯哥大学David Tappin团队研究了英国戒烟服务提供的财政奖券激励对孕妇戒烟的影响。2022年10月19日出版的《英国医学杂志》发表了这项成果。

为了评估除英国组织的各种戒烟服务外，怀孕期间戒烟的经济激励措施的有效性、成本效益、普遍性和可接受性，研究组进行了一项实用型、多中心、单盲、临床3期、随机对照试验（戒烟妊娠奖励试验3期（CPIT III）），在英国苏格兰、北爱尔兰和英格兰的初级和中级保健机构提供了七项戒烟服务。

944名孕妇（年龄≥16岁）在怀孕不到24周的第一次产前检查被询问时自称是吸烟者（过去一周至少吸过一支烟），并通过常规戒烟服务通知试验组。对照组的参与者获得了标准的戒烟服务，包括由受过专门培训的工作人员使用戒断导向疗法提供咨询，并提供免费的尼古丁替代疗法。干预组由戒烟服务机构提供常规支持，并增加高达400英镑（440美元；455欧元）的LoveToShop金融券奖励，用于在怀孕期间使用当前的戒烟服务或戒烟，或两者兼而有之。

主要结局为自我报告的妊娠晚期（妊娠34至38周）戒烟情况，并得到唾液可替宁（如果使用尼古丁替代品，则为新烟碱）证实。结局根据年龄、吸烟年限、多重剥夺指数、Fagerström评分、新冠肺炎前后和招募机构进行了校正。次要结局包括预期分娩日期后6个月的点戒烟和持续戒烟、戒烟服务的参与、戒烟日期后4周的生物化学验证戒烟、婴儿出生体重、成本效益、戒烟服务格式的通用性、孕妇及其护理者的可接受性。

2018年1月9日至2020年4月4日，在4032名接受戒烟服务筛查的女性中，944人被随机分为干预组（n=471）和对照组（n=470）。三名参与者要求删除她们的数据。干预组471名参与者中有126名（27%）戒烟，对照组470名中有58名（12%），校正后的优势比为2.78。严重不良事件包括流产和其他需要住院的预期妊娠事件；所有严重不良事件均与干预无关。两组中大多数戒烟者在婴儿出生后都会复发。

研究结果表明，作为目前英国戒烟服务的补充，提供高达400英镑的金融券奖励促进孕妇戒烟非常有效。这一附加干预措施支持英国国家健康与护理卓越研究所的新指导方针，其中包括增加财政奖励，以支持孕妇戒烟。为了防止复吸，研究组正在评估对婴儿出生后12个月持续奖励的效果。

附：英文原文

Title: Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial

Author: David Tappin, Lesley Sinclair, Frank Kee, Margaret McFadden, Lyn Robinson-Smith, Alex Mitchell, Ada Keding, Judith Watson, Sinead Watson, Alison Dick, David Torgerson, Catherine Hewitt, Jennifer McKell, Pat Hoddinott, Fiona M Harris, Kathleen A Boyd, Nicola McMeekin, Michael Ussher, Linda Bauld

Issue&Volume: 2022/10/19

Abstract:

Objective To examine effectiveness, cost effectiveness, generalisability, and acceptability of financial incentives for smoking cessation during pregnancy in addition to variously organised UK stop smoking services.

Design Pragmatic, multicentre, single blinded, phase 3, randomised controlled trial (Cessation in Pregnancy Incentives Trial phase 3 (CPIT III)).

Setting Seven UK stop smoking services provided in primary and secondary care facilities in Scotland, Northern Ireland, and England.

Participants 944 pregnant women (age ≥16 years) who self-reported as being smokers (at least one cigarette in the past week) when asked at first maternity visit, less than 24 weeks’ gestation, and notified to the trial team by routine stop smoking services.

Interventions Participants in the control group were offered the standard stop smoking services, which includes the offer of counselling by specially trained workers using withdrawal orientated therapy and the offer of free nicotine replacement therapy. The intervention was the offer of usual support from the stop smoking services and the addition of up to ￡400 ($440; €455) of LoveToShop financial voucher incentives for engaging with current stop smoking services or to stop smoking, or both, during pregnancy.

Main outcome measures Self-reported smoking cessation in late pregnancy (between 34 and 38 weeks’ gestation) corroborated by saliva cotinine (and anabasine if using nicotine replacement products). Results were adjusted for age, smoking years, index of multiple deprivation, Fagerstrm score, before or after covid, and recruitment site. Secondary outcomes included point and continuous abstinence six months after expected date of delivery, engagement with stop smoking services, biochemically validated abstinence from smoking at four weeks after stop smoking date, birth weight of baby, cost effectiveness, generalisability documenting formats of stop smoking services, and acceptability to pregnant women and their carers.

Results From 9 January 2018 to 4 April 2020, of 4032 women screened by stop smoking services, 944 people were randomly assigned to the intervention group (n=471) or the control group (n=470). Three people asked for their data to be removed. 126 (27%) of 471 participants stopped smoking from the intervention group and 58 (12%) of 470 from the control group (adjusted odds ratio 2.78 (1.94 to 3.97) P<0.001). Serious adverse events were miscarriages and other expected pregnancy events requiring hospital admission; all serious adverse events were unrelated to the intervention. Most people who stopped smoking from both groups relapsed after their baby was born.

Conclusions The offer of up to ￡400 of financial voucher incentives to stop smoking during pregnancy as an addition to current UK stop smoking services is highly effective. This bolt-on intervention supports new guidance from the UK National Institute for Health and Care Excellence, which includes the addition of financial incentives to support pregnant women to stop smoking. Continuing incentives to 12 months after birth is being examined to prevent relapse.

DOI: 10.1136/bmj-2022-071522

Source: https://www.bmj.com/content/379/bmj-2022-071522