Efficacy of Financial IncentivesNCT01801384
Voucher Based Incentives to Treat Pregnant Smokers
A study testing Voucher-based incentives in people with Efficacy of Financial Incentives, run by University of Vermont at 1 site in United States.
Trial summary
The major goal of this project is to examine the efficacy of a voucher-based incentive program for promoting smoking cessation (Study 1) and preventing relapse (Study 2) during pregnancy and postpartum. Read more about this study
- Who is it for?
- Ages 18 to 45 years, women only
- Conditions the study is for
- Efficacy of Financial Incentives
- What is being tested?
- Voucher-based incentives
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 166 participants
- Where
- 1 siteUnited States
- Study dates
- Apr 2006to May 2011
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 45 years
- Women only
- No healthy volunteers
- Adult
Inclusion Criteria: Only women will participate in the proposed study, because the overarching aim is to develop efficacious treatments for smoking cessation and relapse prevention during pregnancy and early postpartum. All participants will be currently pregnant and report being smokers at the time of conception. Those in Study 1 will report continuing to smoke upon entering prenatal care. Those in Study 2 will report having already quit smoking upon entering prenatal care. Women must reside in the county in which the clinic is located, plan to reside in this geographical area through 6 months postpartum, be < 25 weeks gestation, not be living in a group residence, English speaking, and not regularly receiving psychotropics other than antidepressants.
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Exclusion Criteria: Women receiving opioid substitution therapy will be excluded. In Vermont, minorities comprise 4% of the general population. There will be no exclusion criteria concerning race or ethnicity. In our studies during the prior funding period, approximately 5% of participants were minorities. We anticipate a similar sample in the proposed studies. We shall do all that we can to assure that minorities are included in the research.
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Trial locations and contacts
1 site in 1 country.
United States1 site
Substance Abuse Treatment Center, University of Vermont; UHC
Burlington, Vermont, 05401
About this study
Official title: Phase 2 Study of the Efficacy of Voucher-Based Incentives to Treat Pregnant Smokers
The major goal of this project is to examine the efficacy of a voucher-based incentive program for promoting smoking cessation (Study 1) and preventing relapse (Study 2) during pregnancy and postpartum. Identifying efficacious interventions to increase cessation rates and decrease relapse among those who are able to quit is important to improving U.S. public health.
Read the detailed description
Maternal cigarette smoking is the leading preventable cause of poor pregnancy outcomes and pediatric morbidity and mortality in the U.S. Efficacious interventions have been developed for smoking cessation during pregnancy, but cessation rates are low, typically under 20%. Efficacious interventions to prevent postpartum relapse remain to be developed. This application seeks support for a Stage II behavioral therapies development project to continue examining interventions to increase smoking cessation above the low levels noted above and to decrease postpartum relapse.
With regard to cessation, we conducted studies during the prior funding period showing that voucher-based incentives delivered contingent on biochemically-verified abstinence promote smoking cessation in approximately 40% of women who were still smoking at their 1st prenatal visit compared to only 9% in a control condition. Comparable studies on decreasing postpartum relapse among women who were smokers upon learning of their pregnancy but quit by their 1st prenatal visit (spontaneous quitters) supported the efficacy of abstinence-contingent vouchers for preventing antepartum but not postpartum relapse. We also completed secondary studies on appropriate cutpoints for biochemically verifying smoking status in pregnant women, characterizing the quantitative relationship between smoking exposure and fetal growth, the time-course of depressive symptoms during pregnancy in smokers and abstainers, and the incidence and severity of nicotine withdrawal.
While the treatment effect on smoking cessation during pregnancy noted above is at least two-fold greater than usual outcomes, the majority of women, especially heavier smokers (> 10 cigs/day), failed to quit. In Study 1 of this application we propose to experimentally examine whether a revised voucher program designed to increase initial abstinence and encourage additional quit attempts among those who initially fail can promote cessation at the end-of-pregnancy assessment in the majority of women treated (> 60%). Considering that nobody has succeeded in decreasing postpartum relapse among spontaneous quitters, we are not surprised that our first effort was unsuccessful. In Study 2 of this application we propose to experimentally test whether a revised voucher-based incentive program designed to more effectively reinforce sustained abstinence will decrease postpartum relapse. We are also proposing to continue secondary studies on biochemical verification of smoking status, fetal growth, and predictors of postpartum relapse.
Overall, the proposed studies have the potential to contribute important new information on effective treatments for one of our nation's most daunting drug abuse problems.
- Conditions
- Efficacy of Financial Incentives
- Being tested
- Voucher-based incentives
- Keywords
- pregnancy, cigarette smoking, incentives, smoking cessation, birth outcomes
- Medical subject headings
- Cigarette Smoking, Smoking Cessation
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Voucher-based incentivesBehavioural
Also called Contingency Management
| Study group | Role | What they receive |
|---|---|---|
| Original contingent vouchers schedule | Experimental | Women will receive an abstinence-contingent voucher-based incentives intervention (Contingency Management) for smoking cessation and relapse prevention. Receives: Behavioral: Voucher-based incentives |
| Revised contingent vouchers schedule | Experimental | Women receive abstinence-contingent voucher-based incentives (Contingency Management) intervention designed to further increase cessation and relapse prevention rates. Receives: Behavioral: Voucher-based incentives |
| Non-contingent vouchers schedule | Sham comparator | This serves as a control condition wherein women earn incentives independent of smoking status. Receives: Behavioral: Voucher-based incentives |
What is being measured
The primary outcome is the main question the study is designed to answer.
Biochemical verification of smoking status.
Measured: 15 months
Secondary outcomes (1)
birth outcomes
Assessing the impact of smoking cessation on birth outcomes.
Measured: 9 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Feb 2013 (estimated)
- Study startApr 2006
- Primary completionMay 2011
- Study completionMay 2011
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (12)Papers the sponsor has linked to this study.
- Other trials for Efficacy of Financial IncentivesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 166 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Vermont
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Stephen T. Higgins, PhD, University of Vermont
- Investigators
- Stephen T Higgins, Ph.D., Principal investigator, University of Vermont
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01801384
- Sponsor's protocol ID
- R01DA014028
- Status last verified
- Mar 2013
- First submitted
- 26 Feb 2013
- Last updated
- 12 May 2023
- Results posted
- No
- Data monitoring committee
- No
Publications
Solomon LJ, Higgins ST, Heil SH, Badger GJ, Mongeon JA, Bernstein IM. Psychological symptoms following smoking cessation in pregnant smokers. J Behav Med. 2006 Apr;29(2):151-60. doi: 10.1007/s10865-005-9041-4. Epub 2006 Mar 14.
PubMed 16534659Higgins ST, Heil SH, Badger GJ, Mongeon JA, Solomon LJ, McHale L, Bernstein IM. Biochemical verification of smoking status in pregnant and recently postpartum women. Exp Clin Psychopharmacol. 2007 Feb;15(1):58-66. doi: 10.1037/1064-1297.15.1.58.
PubMed 17295585Solomon LJ, Higgins ST, Heil SH, Badger GJ, Thomas CS, Bernstein IM. Predictors of postpartum relapse to smoking. Drug Alcohol Depend. 2007 Oct 8;90(2-3):224-7. doi: 10.1016/j.drugalcdep.2007.03.012. Epub 2007 May 1.
PubMed 17475418Yoon JH, Higgins ST, Heil SH, Sugarbaker RJ, Thomas CS, Badger GJ. Delay discounting predicts postpartum relapse to cigarette smoking among pregnant women. Exp Clin Psychopharmacol. 2007 Apr;15(2):176-86. doi: 10.1037/1064-1297.15.2.186.
PubMed 17469941Heil SH, Higgins ST, Bernstein IM, Solomon LJ, Rogers RE, Thomas CS, Badger GJ, Lynch ME. Effects of voucher-based incentives on abstinence from cigarette smoking and fetal growth among pregnant women. Addiction. 2008 Jun;103(6):1009-18. doi: 10.1111/j.1360-0443.2008.02237.x.
PubMed 18482424Higgins ST, Chilcoat HD. Women and smoking: an interdisciplinary examination of socioeconomic influences. Drug Alcohol Depend. 2009 Oct 1;104 Suppl 1(Suppl 1):S1-5. doi: 10.1016/j.drugalcdep.2009.06.006. Epub 2009 Jul 8. No abstract available.
PubMed 19586726Higgins ST, Heil SH, Badger GJ, Skelly JM, Solomon LJ, Bernstein IM. Educational disadvantage and cigarette smoking during pregnancy. Drug Alcohol Depend. 2009 Oct 1;104 Suppl 1(Suppl 1):S100-5. doi: 10.1016/j.drugalcdep.2009.03.013. Epub 2009 May 12.
PubMed 19442460Linares Scott TJ, Heil SH, Higgins ST, Badger GJ, Bernstein IM. Depressive symptoms predict smoking status among pregnant women. Addict Behav. 2009 Aug;34(8):705-8. doi: 10.1016/j.addbeh.2009.04.003. Epub 2009 Apr 19.
PubMed 19411145Heil SH, Higgins ST, Mongeon JA, Badger GJ, Bernstein IM. Characterizing nicotine withdrawal in pregnant cigarette smokers. Exp Clin Psychopharmacol. 2006 May;14(2):165-70. doi: 10.1037/1064-1297.14.2.165.
PubMed 16756420Higgins ST, Heil SH, Dumeer AM, Thomas CS, Solomon LJ, Bernstein IM. Smoking status in the initial weeks of quitting as a predictor of smoking-cessation outcomes in pregnant women. Drug Alcohol Depend. 2006 Nov 8;85(2):138-41. doi: 10.1016/j.drugalcdep.2006.04.005. Epub 2006 May 23.
PubMed 16720082Heil, S.H., Yoon, J.H. & Higgins, S.T., (2008). Pregnant and Postpartum Women. In S.T. Higgins, K. Silverman, & S.H. Heil (Eds.), Contingency management in substance abuse treatment (pp. 182-201). New York, NY: The Guilford Press.
Higgins ST, Washio Y, Lopez AA, Heil SH, Solomon LJ, Lynch ME, Hanson JD, Higgins TM, Skelly JM, Redner R, Bernstein IM. Examining two different schedules of financial incentives for smoking cessation among pregnant women. Prev Med. 2014 Nov;68:51-7. doi: 10.1016/j.ypmed.2014.03.024. Epub 2014 Apr 2.
PubMed 24704135
Study at a glance
From the registry record, last updated by the sponsor on 12 May 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Phase 2 Study of the Efficacy of Voucher-Based Incentives to Treat Pregnant Smokers
- ClinicalTrials.gov ID
- NCT01801384
- Acronym / sponsor ID
- R01DA014028
- Conditions
- Efficacy of Financial Incentives
- Keywords
- pregnancy, cigarette smoking, incentives, smoking cessation, birth outcomes
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 166 participants (actual)
- Lead sponsor
- University of VermontUniversity, hospital or other
- Study start
- Apr 2006 (actual)
- Primary completion
- May 2011 (actual)
- Study completion
- May 2011 (actual)
- First posted
- 28 Feb 2013 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The major goal of this project is to examine the efficacy of a voucher-based incentive program for promoting smoking cessation (Study 1) and preventing relapse (Study 2) during pregnancy and postpartum. Identifying efficacious interventions to increase cessation rates and decrease relapse among those who are able to quit is important to improving U.S. public health.
Detailed description
Maternal cigarette smoking is the leading preventable cause of poor pregnancy outcomes and pediatric morbidity and mortality in the U.S. Efficacious interventions have been developed for smoking cessation during pregnancy, but cessation rates are low, typically under 20%. Efficacious interventions to prevent postpartum relapse remain to be developed. This application seeks support for a Stage II behavioral therapies development project to continue examining interventions to increase smoking cessation above the low levels noted above and to decrease postpartum relapse.
With regard to cessation, we conducted studies during the prior funding period showing that voucher-based incentives delivered contingent on biochemically-verified abstinence promote smoking cessation in approximately 40% of women who were still smoking at their 1st prenatal visit compared to only 9% in a control condition. Comparable studies on decreasing postpartum relapse among women who were smokers upon learning of their pregnancy but quit by their 1st prenatal visit (spontaneous quitters) supported the efficacy of abstinence-contingent vouchers for preventing antepartum but not postpartum relapse. We also completed secondary studies on appropriate cutpoints for biochemically verifying smoking status in pregnant women, characterizing the quantitative relationship between smoking exposure and fetal growth, the time-course of depressive symptoms during pregnancy in smokers and abstainers, and the incidence and severity of nicotine withdrawal.
While the treatment effect on smoking cessation during pregnancy noted above is at least two-fold greater than usual outcomes, the majority of women, especially heavier smokers (> 10 cigs/day), failed to quit. In Study 1 of this application we propose to experimentally examine whether a revised voucher program designed to increase initial abstinence and encourage additional quit attempts among those who initially fail can promote cessation at the end-of-pregnancy assessment in the majority of women treated (> 60%). Considering that nobody has succeeded in decreasing postpartum relapse among spontaneous quitters, we are not surprised that our first effort was unsuccessful. In Study 2 of this application we propose to experimentally test whether a revised voucher-based incentive program designed to more effectively reinforce sustained abstinence will decrease postpartum relapse. We are also proposing to continue secondary studies on biochemical verification of smoking status, fetal growth, and predictors of postpartum relapse.
Overall, the proposed studies have the potential to contribute important new information on effective treatments for one of our nation's most daunting drug abuse problems.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Original contingent vouchers schedule | Experimental | Behavioral: Voucher-based incentivesWomen will receive an abstinence-contingent voucher-based incentives intervention (Contingency Management) for smoking cessation and relapse prevention. |
| Revised contingent vouchers schedule | Experimental | Behavioral: Voucher-based incentivesWomen receive abstinence-contingent voucher-based incentives (Contingency Management) intervention designed to further increase cessation and relapse prevention rates. |
| Non-contingent vouchers schedule | Sham comparator | Behavioral: Voucher-based incentivesThis serves as a control condition wherein women earn incentives independent of smoking status. |
Who may qualify
- Ages
- 18 to 45 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Voucher-based incentivesAlso: Contingency Management | Behavioural | Non-contingent vouchers schedule, Original contingent vouchers schedule, Revised contingent vouchers schedule |
Primary outcome
Biochemical verification of smoking status.
Time frame: 15 months
1 secondary outcome
birth outcomes
Time frame: 9 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 May 2023.
- Background: PubMed 16534659Solomon LJ, Higgins ST, Heil SH, Badger GJ, Mongeon JA, Bernstein IM. Psychological symptoms following smoking cessation in pregnant smokers. J Behav Med. 2006 Apr;29(2):151-60. doi: 10.1007/s10865-005-9041-4. Epub 2006 Mar 14.
- Background: PubMed 17295585Higgins ST, Heil SH, Badger GJ, Mongeon JA, Solomon LJ, McHale L, Bernstein IM. Biochemical verification of smoking status in pregnant and recently postpartum women. Exp Clin Psychopharmacol. 2007 Feb;15(1):58-66. doi: 10.1037/1064-1297.15.1.58.
- Background: PubMed 17475418Solomon LJ, Higgins ST, Heil SH, Badger GJ, Thomas CS, Bernstein IM. Predictors of postpartum relapse to smoking. Drug Alcohol Depend. 2007 Oct 8;90(2-3):224-7. doi: 10.1016/j.drugalcdep.2007.03.012. Epub 2007 May 1.
- Background: PubMed 17469941Yoon JH, Higgins ST, Heil SH, Sugarbaker RJ, Thomas CS, Badger GJ. Delay discounting predicts postpartum relapse to cigarette smoking among pregnant women. Exp Clin Psychopharmacol. 2007 Apr;15(2):176-86. doi: 10.1037/1064-1297.15.2.186.
- Background: PubMed 18482424Heil SH, Higgins ST, Bernstein IM, Solomon LJ, Rogers RE, Thomas CS, Badger GJ, Lynch ME. Effects of voucher-based incentives on abstinence from cigarette smoking and fetal growth among pregnant women. Addiction. 2008 Jun;103(6):1009-18. doi: 10.1111/j.1360-0443.2008.02237.x.
- Background: PubMed 19586726Higgins ST, Chilcoat HD. Women and smoking: an interdisciplinary examination of socioeconomic influences. Drug Alcohol Depend. 2009 Oct 1;104 Suppl 1(Suppl 1):S1-5. doi: 10.1016/j.drugalcdep.2009.06.006. Epub 2009 Jul 8. No abstract available.
- Background: PubMed 19442460Higgins ST, Heil SH, Badger GJ, Skelly JM, Solomon LJ, Bernstein IM. Educational disadvantage and cigarette smoking during pregnancy. Drug Alcohol Depend. 2009 Oct 1;104 Suppl 1(Suppl 1):S100-5. doi: 10.1016/j.drugalcdep.2009.03.013. Epub 2009 May 12.
- Background: PubMed 19411145Linares Scott TJ, Heil SH, Higgins ST, Badger GJ, Bernstein IM. Depressive symptoms predict smoking status among pregnant women. Addict Behav. 2009 Aug;34(8):705-8. doi: 10.1016/j.addbeh.2009.04.003. Epub 2009 Apr 19.
- Results publication: PubMed 16756420Heil SH, Higgins ST, Mongeon JA, Badger GJ, Bernstein IM. Characterizing nicotine withdrawal in pregnant cigarette smokers. Exp Clin Psychopharmacol. 2006 May;14(2):165-70. doi: 10.1037/1064-1297.14.2.165.
- Results publication: PubMed 16720082Higgins ST, Heil SH, Dumeer AM, Thomas CS, Solomon LJ, Bernstein IM. Smoking status in the initial weeks of quitting as a predictor of smoking-cessation outcomes in pregnant women. Drug Alcohol Depend. 2006 Nov 8;85(2):138-41. doi: 10.1016/j.drugalcdep.2006.04.005. Epub 2006 May 23.
- Results publicationHeil, S.H., Yoon, J.H. & Higgins, S.T., (2008). Pregnant and Postpartum Women. In S.T. Higgins, K. Silverman, & S.H. Heil (Eds.), Contingency management in substance abuse treatment (pp. 182-201). New York, NY: The Guilford Press.
- Derived from this study: PubMed 24704135Higgins ST, Washio Y, Lopez AA, Heil SH, Solomon LJ, Lynch ME, Hanson JD, Higgins TM, Skelly JM, Redner R, Bernstein IM. Examining two different schedules of financial incentives for smoking cessation among pregnant women. Prev Med. 2014 Nov;68:51-7. doi: 10.1016/j.ypmed.2014.03.024. Epub 2014 Apr 2.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Stephen T Higgins, Ph.D. principal investigator
University of Vermont
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Voucher-based incentives in people with Efficacy of Financial Incentives, run by University of Vermont at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 12 May 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Biochemical verification of smoking status. (time frame: 15 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01801384, which also lists 12 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 May 2023.