Contingency Management for Smoking Cessation in Pregnant Minority Women

The long-term goal of this research is to reduce tobacco-related disparities in maternal and
infant health outcomes by improving smoking cessation and relapse prevention interventions
for minority pregnant and postpartum women, who have been significantly underrepresented in
smoking cessation research. This study will examine the feasibility and efficacy of a
prize-based contingency management approach for increasing smoking cessation and preventing
relapse among socioeconomically disadvantaged minority pregnant smokers. First, the
intervention will be pretested with 10 pregnant low-income minority smokers and then refined
based on acceptability survey and focus group data. Next, a pilot study will be conducted. 60
highly disadvantaged minority women, recruited from the outpatient obstetric clinics at a
large teaching hospital, who report daily smoking and who meet other eligibility criteria
will be enrolled and randomized to one of two study conditions: 1) Standard Psychoeducational
Intervention (6-week, individually-administered, pregnancy-specific Quit Smoking Now
curriculum, as currently implemented in the clinic; QSN Only); 2) Standard Psychoeducational
Intervention plus Contingency Management (provision of incentives contingent on
biochemically-verified abstinence; QSN-CM). Abstinence monitoring via expired carbon monoxide
and salivary cotinine levels will occur in both groups beginning on the first quit day and
continuing through 3-months postpartum. Only participants in the QSN-CM group will be
reinforced for biochemically-verified abstinence with chances to win prizes ranging in value
from approximately $1 to $100 ('fishbowl' or 'prize bowl' method). Study outcomes will be
assessed through follow-up research exams (delivery and 6-months postpartum) and hospital
chart reviews. The primary hypothesis is that that women randomized to the QSN-CM condition
will have higher rates of abstinence during pregnancy and postpartum compared to women
receiving standard of care alone. Results should advance scientific knowledge regarding
effective methods for promoting and maintaining smoking abstinence among pregnant
disadvantaged women and provide preliminary feasibility and efficacy data needed to support a
larger randomized controlled trial.