对两种不同的孕妇戒烟奖励方案进行评估
2014/06/17
摘要
目的：评估用以减少孕妇吸烟和促进胎儿生长的有效代金奖励干预能否在不增加成本的情况下得到改善。本策略旨在对常规的奖励进行重新分配，从而使受试者在试图戒烟早期就能获得更高的奖励。
方法：将柏林顿佛蒙特州（2006-2011年间）的118位孕妇吸烟者分配为以下三组：第一、二组受试者达到戒烟才可获得代金奖励，其中第一组采用修改后代金奖励方案（RCV），第二组采用常规代金奖励方案（CV）；而第三组受试者无论吸烟状态如何均可获得代金奖励（NCV）。采用生化检查确定吸烟状态；收集30-34孕周的连续B超数据，观察胎儿生长情况。
结果：在怀孕早期(RCV: 40%, CV: 46%, NCV: 13%, p=0.007)和晚期(RCV: 45%; CV: 36%; NCV, 18%; p=0.04)，RCV和CV组的现戒烟率均高于NCV组，但是RCV组和CV组之间戒烟水平无差异。与对照组水平相比，RCV干预未促进胎儿生长，但CV干预可促进胎儿生长。
结论：本试验进一步证实CV具有促进产前戒烟和胎儿生长的功效，但仍需其他方案（例如增加总奖励值）以进一步改善结果。
（刘国梁 审校）
Prev Med. 2014 Apr 2. pii: S0091-7435(14)00118-2. doi: 10.1016/j.ypmed.2014.03.024. [Epub ahead of print]
Examining two different schedules of financial incentives for smoking cessation among pregnant women.
Higgins ST1, Washio Y2, Lopez AA3, Heil SH3, Solomon LJ4, Lynch ME5, Hanson JD2, Higgins TM2, Skelly JM6, Redner R5, Bernstein IM7.
ABSTRACT
OBJECTIVE: To examine whether an efficacious voucher-based incentives intervention for decreasing smoking during pregnancy and increasing fetal growth could be improved without increasing costs. The strategy was to redistribute the usual incentives so that higher values were available early in the quit attempt.
METHOD: 118 pregnant smokers in greater Burlington, Vermont (studied 2006-2011) were randomly assigned to the revised contingent voucher (RCV) or usual contingent voucher (CV) schedule of abstinence-contingent vouchers, or to a non-contingent voucher (NCV) control condition wherein vouchers were provided independent of smoking status. Smoking status was biochemically verified; serial sonographic estimates of fetal growth were obtained at gestational weeks 30-34.
RESULTS: RCV and CV conditions increased point-prevalence abstinence above NCV levels at early (RCV: 40%, CV: 46%, NCV: 13%, p=.007) and late-pregnancy (RCV: 45%; CV: 36%; NCV, 18%; p=.04) assessments, but abstinence levels did not differ between the RCV and CV conditions. The RCV intervention did not increase fetal growth above control levels while the CV condition did so (p<.05).
CONCLUSION: This trial further supports the efficacy of CV for increasing antepartum abstinence and fetal growth, but other strategies (e.g., increasing overall incentive values) will be necessary to improve outcomes further.
Prev Med. 2014 Apr 2. pii: S0091-7435(14)00118-2. doi: 10.1016/j.ypmed.2014.03.024. [Epub ahead of print]
