法国索邦大学皮蒂·萨尔皮特里医院Ivan Berlin团队研究了经济激励对怀孕期间戒烟的影响。2021年12月1日，《英国医学杂志》发表了这一成果。
为了评估依赖于持续戒烟的经济激励措施对怀孕吸烟者戒烟和分娩结局的影响，研究组进行了一项单盲、随机对照试验。
他们在法国18个产科病房进行了这项怀孕期间戒烟经济激励试验，共招募了460名年龄在18岁以上、每日吸烟≥5支或每日吸自卷香烟≥3支、怀孕<18周的孕妇，将其随机分组，其中经济激励组231例，对照组229例。
对照组参与者没有因为戒烟而获得经济奖励。所有参与者在六次随访中每次获得20欧元的随访费。主要观察指标为从第一次戒烟后随访到分娩前第6次随访间的持续禁烟。这些母亲的次要结局是在过去30天内的点戒烟率、吸烟复发时间、戒断症状、血压以及酒精和大麻的使用。婴儿的次要结局是出生时的胎龄、出生特征（出生体重、身长、头围、Apgar评分）和不良新生儿结局（转移到新生儿病房、先天畸形、惊厥或围产期死亡的综合衡量指标）。
参与者的平均年龄为29岁。在经济激励组和对照组中，分别有137人（59%）和148人（65%）有工作，163人（71%）和171人（75%）处于恋爱中，41人（18%）和31人（13%）已婚。在过去的七天里，参与者平均抽了60支香烟。
经济激励组的持续戒断率为16%，显著高于对照组的7%，优势比为2.45。经济激励组的点戒断率较高，中位复吸时间较长，对烟草的渴求较低。经济激励组中有4名婴儿（2%）发生不良新生儿结局，显著低于对照组的18名婴儿（9%）。
事后分析表明，与对照组相比，经济激励组中有更多的婴儿出生体重≥2500克：未校正的优势比为1.95；性别校正后的优势比为2.05；性别和早产校正后的优势比为2.06。由于这些是事后分析，因此应谨慎解释结果。
研究结果表明，与无经济激励相比，奖励戒烟的经济激励与怀孕吸烟者的戒烟率增加相关。依赖于戒烟的经济激励措施可作为一种安全有效的干预措施来实施，以帮助怀孕吸烟者戒烟。
附：英文原文
Title: Financial incentives for smoking cessation in pregnancy: multicentre randomised controlled trial
Author: Ivan Berlin, Noémi Berlin, Marie Malecot, Martine Breton, Florence Jusot, Léontine Goldzahl
Issue&Volume: 2021/12/01
Abstract:
Objective To evaluate the efficacy of financial incentives dependent on continuous smoking abstinence on smoking cessation and birth outcomes among pregnant smokers.
Design Single blind, randomised controlled trial.
Setting Financial Incentive for Smoking Cessation in Pregnancy (FISCP) trial in 18 maternity wards in France.
Participants 460 pregnant smokers aged at least 18 years who smoked ≤5 cigarettes/day or ≤3 roll-your-own cigarettes/day and had a pregnancy gestation of <18 weeks were randomised to a financial incentives group (n=231) or a control group (n=229).
Interventions Participants in the financial incentives group received a voucher equivalent to €20 (￡17; $23), and further progressively increasing vouchers at each study visit if they remained abstinent. Participants in the control group received no financial incentive for abstinence. All participants received a €20 show-up fee at each of six visits.
Main outcome measures The main outcome measure was continuous smoking abstinence from the first post-quit date visit to visit 6, before delivery. Secondary outcomes in the mothers were point prevalence abstinence, time to smoking relapse, withdrawal symptoms, blood pressure, and alcohol and cannabis use in past 30 days. Secondary outcomes in the babies were gestational age at birth, birth characteristics (birth weight, length, head circumference, Apgar score), and a poor neonatal outcome—a composite measure of transfer to the neonatal unit, congenital malformation, convulsions, or perinatal death.
Results Mean age was 29 years. In the financial incentives and control groups, respectively, 137 (59%) and 148 (65%) were employed, 163 (71%) and 171 (75%) were in a relationship, and 41 (18%) and 31 (13%) were married. The participants had smoked a median of 60 cigarettes in the past seven days. The continuous abstinence rate was significantly higher in the financial incentives group (16%, 38/231) than control group (7%, 17/229): odds ratio 2.45 (95% confidence interval 1.34 to 4.49), P=0.004). The point prevalence abstinence rate was higher (4.61, 1.41 to 15.01, P=0.011), the median time to relapse was longer (visit 5 (interquartile range 3-6) and visit 4 (3-6), P<0.001)), and craving for tobacco was lower (β=1.81, 95% confidence interval 3.55 to 0.08, P=0.04) in the financial incentives group than control group. Financial incentives were associated with a 7% reduction in the risk of a poor neonatal outcome: 4 babies (2%) in the financial incentives group and 18 babies (9%) in the control group: mean difference 14 (95% confidence interval 5 to 23), P=0.003. Post hoc analyses suggested that more babies in the financial incentives group had birth weights ≥2500 g than in the control group: unadjusted odds ratio 1.95 (95% confidence interval 0.99 to 3.85), P=0.055; sex adjusted odds ratio 2.05 (1.03 to 4.10), P=0.041; and sex and prematurity adjusted odds ratio 2.06 (0.90 to 4.71), P=0.086. As these are post hoc analyses, the results should be interpreted with caution.
Conclusions Financial incentives to reward smoking abstinence compared with no financial incentives were associated with an increased abstinence rate in pregnant smokers. Financial incentives dependent on smoking abstinence could be implemented as a safe and effective intervention to help pregnant smokers quit smoking.
DOI: 10.1136/bmj-2021-065217
Source: https://www.bmj.com/content/375/bmj-2021-065217
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
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本期文章：《英国医学杂志》：Online/在线发表
