A newly updated Cochrane study has emphasised the usefulness of financial incentives in helping people quit smoking, with ground-breaking findings confirming high-certainty evidence that these strategies are helpful even in pregnant populations. The review, coordinated by a University of Massachusetts Amherst public health expert, emphasises the potential of monetary rewards to address a recurring public health concern. 

Previous assessments assigned considerable certainty to financial incentives for helping pregnant women to quit smoking. However, the new review, which includes more recent studies, raises the evidence to high certainty. "When we updated this review, we found more studies of financial incentives in pregnant people and found high-certainty evidence that they help pregnant people quit smoking and stay quit," explained Jamie Hartmann-Boyce, senior author and assistant professor of health policy and promotion at UMass Amherst. 

Smoking during pregnancy poses severe dangers to both the parent and the foetus, making quitting attempts extremely important. "We know that smoking while pregnant can be really harmful to both the parents and the foetus," she said. "And pregnant women are more hesitant to use many of the pharmacological therapies recommended for smoking cessation. That's why we're concentrating on strategies to assist pregnant people in quitting smoking." 

The comprehensive study included 47 research studies with mixed populations from the United States, Europe, Southeast Asia, Hong Kong, and South Africa. Among them were 14 new research studies with roughly 22,000 participants. The researchers discovered continuous, high-certainty evidence that financial incentives enhanced smoking cessation rates even after the awards were removed. 

A subgroup of 13 research studies focused solely on pregnant participants and included data from the United States, United Kingdom, and France. These trials, which included 3,942 pregnant women, found a significant impact: for every 100 pregnant women offered financial incentives, 13 successfully stopped smoking for six months or longer, compared to only six out of 100 who did not get incentives. 

Interestingly, the research indicated that the amount of the financial incentive—whether cash or vouchers—had no significant effect on the quit rate. Incentives varied greatly, from self-deposits returned upon cessation to amounts ranging from $45 to $1,185. Despite this diversity, the researchers found that there was insufficient information to determine if the value of rewards influenced quitting rates. 

The University of East Anglia (UEA) led this collaborative initiative, which also included UMass Amherst, the University of Oxford, and the University of Edinburgh. Caitlin Notley, lead author and professor of addiction sciences at UEA's Norwich Medical School, emphasised the significance of these findings: "Smoking is the leading preventable cause of illness and premature death worldwide, and quitting smoking is critical to helping people live in good health for longer." We are now certain that incentives assist people, including pregnant women, in quitting smoking more effectively than other methods." 

Despite the strong evidence supporting financial incentives, Hartmann-Boyce acknowledged general scepticism towards such initiatives. "Many individuals are opposed to making compensation available to persons who use substances—specifically because they use those substances. But it would benefit everyone if more individuals could quit smoking," she remarked. 

Hartmann-Boyce cited California's pioneering program as an example of success. In 2021, California became the first state in the United States to provide financial incentives through Medicaid to help people to stop using stimulants like methamphetamines and cocaine. This strategy, known as "contingency management," is largely considered the gold standard for treating amphetamine use disorder. Since its introduction, 14 additional states have taken similar actions. 

The psychological mechanisms that underpin the effectiveness of financial incentives are critical to understanding their success. "Another common misconception about financial incentives is that all these people can quit smoking because they won't get paid," she said. "Actually, there's a lot of evidence to suggest that this intervention is acting on the psychological reward systems in the brain, which we know are heavily involved with nicotine addiction." 

She also emphasised the difficulties many participants had before finding success through these programs: "A lot of people in these studies have tried to quit many times; they really want to quit but weren't able to do so, and this helped them." 

The findings of this Cochrane review give persuasive evidence that financial incentives are an effective smoking cessation treatment, particularly among pregnant women. As more governments and countries investigate contingency management programs, these initiatives may play a critical role in lowering smoking-related health hazards worldwide.