Source: Oregonian, The Author: Patrick O'Neill of The Oregonian staff Contact: http://www.oregonlive.com/ Pubdate: Tue, 3 Mar 1998 CASH INCENTIVE COULD HELP PREGNANT SMOKER QUIT An OSU study of pregnant women finds that handing out vouchers can overcome the urge for a cigarette The carrot works better than the stick in persuading low-income pregnant women to stop smoking. That is the finding of a new study by researchers at Oregon State University in Corvallis. The study, made public Monday, found that low-income pregnant women were far more likely to stop smoking if they were given vouchers worth $50 a month than if they got only counseling and self-help literature. Women who participated in the study were divided into two groups. The women in the successful group also had friends or spouses who gave moral support during the 10 months each woman was observed. The partners received vouchers for $25 a month except for the first and last months, when they received $50 vouchers. After eight months of pregnancy, 34.6 percent of those who received vouchers were still smoke-free, compared with 9 percent of those who did not. Two months after they delivered their children, 24 percent of those who received vouchers were still smoke-free, compared with 5 percent of the others. The study, done over the last two years, has drawn the attention of the U.S. Air Force which, like other military branches, is struggling with ways to cut smoking. The study will be presented next Monday in a keynote speech by researcher Susan L. Prows, an assistant professor of public health at OSU, during the Air Force Worldwide Prevention Conference, sponsored by the Air Force and the U.S. Surgeon General. Prows authored the study along with Rebecca J. Donatelle, chair of the university's Department of Public Health. The idea of paying people to do something that's good for their health has raised some eyebrows. "It's been somewhat politically controversial," Prows said. "A lot of people say, 'People will quit if you just tell them how bad it is for them.' But we've shown that's not true." Bill Smith, manager of environmental health and tobacco control programs of the American Lung Association of Oregon, called the results interesting. But Smith wondered where a permanent program would find financial support. "The findings are wonderful to see," he said. "But how are we going to fund that kind of thing?" Smith's opinion was echoed by Wendy Rankin, manager of the Multnomah County tobacco reduction program. "It's an interesting idea, but I think it's very expensive and I think selling it be would politically tough," she said. Prows thinks the cost of such a program would be more than offset by savings in health care expenditures. The study, financed with a $240,000 grant from the Robert Wood Johnson Foundation, eventually will assess the cost-effectiveness of the program. If the program is shown to be worth the money, Prows said, she hopes the study will be used to change the way society approaches the problem of smoking. Health costs associated with smoking are enormous. The Oregon Health Division estimates that smoking was responsible for $267 million in medical treatment in Oregon during 1993, the last year for which figures are available. Death certificate information shows that in 1995, 6,274 Oregonians died from smoking-related causes -- 22.3 percent of all deaths in the state. Counted in the overall cost is treatment for children of smoking mothers. Women who smoke during pregnancy are more likely than nonsmokers to bear low birth-weight children. Prows said smoking causes 20 percent of all low birth-weight deliveries. Each low birth-weight child generates $4,000 to $9,000 in added medical expenses, she said. In addition, she said, smoking is estimated to add 10 percent to the cost of pediatric care. Here's how the study worked: 220 pregnant women who agreed to participate were divided into two groups. In one group, the women and their partners received the vouchers, good for merchandise -- except tobacco and alcohol - -- at Fred Meyer stores. They also received counseling and anti-smoking literature. The other group -- called the control group -- got only counseling and literature. Each month the women underwent saliva tests to determine if they really were smoke-free. A total of $50,000 for the vouchers came from private sources, most of which have an interest in cutting smoking, Prows said. Among the donors were Regence BlueCross and BlueShield of Oregon and HMO Oregon, Epitope Inc., Fred Meyer Corp., Good Samaritan Hospital in Corvallis, Albany General Hospital, and the March of Dimes. The real innovation in the approach, Prows said, is that it avoids a punitive approach to quitting smoking. "We were interested in a positive approach and in the social support," she said. Other studies are planned to determine how important it is to have a caring partner to lend support. Prows suspects that social support might be more important than the financial incentive.