This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Maternal cigarette smoking is a leading cause of preventable fetal and infant mortality and morbidity. Despite tremendous efforts to reduce smoking, approximately 30% of U.S. women are cigarette smokers at the time that they become pregnant, 75% of them continue smoking through the pregnancy, and about 33% of those who attempt to quit relapse during the pregnancy. Efficacious cessation interventions have been developed for pregnant smokers, but quit rates are generally low (e.g., 20%), and relapse remains a problem. More effective interventions to promote smoking cessation and prevent relapse in pregnant smokers are sorely needed. In the proposed project we will examine the efficacy of a voucher-based incentive program for increasing quit rates and decreasing relapse among pregnant smokers. Towards that end, three randomized trials are proposed. In the first trial, we will examine the efficacy of vouchers delivered contingent on objective evidence of recent smoking abstinence to promote quit rates among women who are still smoking at their first prenatal visit. The second trial will examine the same topic, but will use the information obtained in Trial 1 to modify the voucher program to improve outcomes. The third trial will examine the efficacy of contingent vouchers to prevent relapse among women who have already initiated a quit attempt at the time of their first prenatal visit. Overall, the proposed trials have the potential to contribute important new scientific information on decreasing smoking and related adverse effects among poor pregnant women and their fetuses/infants.
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