Journal
ADDICTION
Volume 103, Issue 6, Pages 1009-1018Publisher
WILEY-BLACKWELL
DOI: 10.1111/j.1360-0443.2008.02237.x
Keywords
contingency management; fetal growth; pregnant women; smoking cessation; vouchers
Categories
Funding
- NCRR NIH HHS [GCRC M01RR109] Funding Source: Medline
- NIDA NIH HHS [R01DA14028, R01 DA014028-07, R01 DA014028] Funding Source: Medline
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Aims This study examined whether voucher-based reinforcement therapy (VBRT) contingent upon smoking abstinence during pregnancy is an effective method for decreasing maternal smoking during pregnancy and improving fetal growth. Design, setting and participants A two-condition, parallel-groups, randomized controlled trial was conducted in a university-based research clinic. A total of 82 smokers entering prenatal care participated in the trial. Intervention Participants were assigned randomly to either contingent or non-contingent voucher conditions. Vouchers exchangeable for retail items were available during pregnancy and for 12 weeks postpartum. In the contingent condition, vouchers were earned for biochemically verified smoking abstinence; in the non-contingent condition, vouchers were earned independent of smoking status. Measurements Smoking outcomes were evaluated using urine-toxicology testing and self-report. Fetal growth outcomes were evaluated using serial ultrasound examinations performed during the third trimester. Findings Contingent vouchers significantly increased point-prevalence abstinence at the end-of-pregnancy (41% versus 10%) and at the 12-week postpartum assessment (24% versus 3%). Serial ultrasound examinations indicated significantly greater growth in terms of estimated fetal weight, femur length and abdominal circumference in the contingent compared to the non-contingent conditions. Conclusions These results provide further evidence that VBRT has a substantive contribution to make to efforts to decrease maternal smoking during pregnancy and provide new evidence of positive effects on fetal health.
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