Contingent incentives reduce cigarette smoking among pregnant, methadone‐maintained women: results of an initial feasibility and efficacy randomized clinical trial

Abstract

Aims This study examined the feasibility and efficacy of behavioral incentives for reducing cigarette smoking among pregnant methadone-maintained patients. Methods Participants (N=102) were randomly assigned to: 1) contingent behavioral incentives (CBI: n=42); 2) non-contingent behavioral incentives (NCBI: n=28); or 3) treatment as usual (TAU: n=32). Baseline carbon monoxide (CO) levels were calculated for each participant. Subsequently, breath samples were tested three times weekly to measure changes in smoking behavior. CBI participants received incentives for target reductions from baseline: any reduction (week 1); 10% reduction (weeks 2-4), 25% reduction (weeks 5-7), 50% reduction (weeks 8-9), 75% reduction (week 10-11); abstinence (CO<4ppm) (week 12 until delivery). NCBI participants received incentives independent of smoking CO measurement results. TAU participants received no incentives, the standard treatment at the program. Results CBI condition participants submitted significantly lower mean CO values than the NCBI and TAU conditions over the course of the intervention (p<.0001). Nearly half (48%) of the CBI participants, met the 75% smoking reduction target and one third (31%) met the abstinence target at week 12. In contrast, none of the NCBI met either the 75% or abstinence target. Only 2% of the TAU participants met the 75% reduction and none of the TAU participants met the abstinence target. These smoking behavior reductions did not yield significant differences in birth outcomes. Conclusions Cigarette smoking may be significantly reduced among pregnant, methadone-maintained women through the use of contingent reinforcement for gradual reductions in breath carbon monoxide levels.

Cigarette Smoking Reduction in Pregnant Women With Opioid Use Disorder

“…Although this difference was not statistically significant, perhaps due to insufficient power, it trended towards significance (p=0.056). This is consistent with the primary findings from the parent trial, which demonstrated that contingent reinforcement was successful in helping pregnant women with opioid use disorder reduce smoking (Tuten, et al 2012). In addition, the SR group had more mean days of treatment attendance and a greater number of collected urinalysis samples, suggesting that participants who were more actively engaged in treatment were also more likely to be successful at smoking reduction.…”

“…This study has several limitations in addition to those described previously (Tuten, et al 2012). First, birth outcome data were available for a relatively small sub-set of participants whose medical record data were available for extraction.…”

“…This study is a secondary analysis of maternal smoking reduction and infant birth outcomes for participants enrolled in the parent trial (Tuten, et al 2012). In this secondary analysis, participants from the parent trial were grouped into clinically relevant categories based upon study smoking patterns, and defined below:…”

“…Trial results showed that half of CBI participants met the 75% smoking reduction target and one-third of CBI participants met the abstinence target demand (Tuten, et al 2012). These outcomes were far superior to the smoking reduction and abstinence outcomes for the NCBI and TAU conditions.…”

“…The authors hypothesize that assignment to CBI condition, lower levels of nicotine dependence, and lower levels of poly-substance use will be associated with successful smoking reduction. Prior studies have identified these variables as playing a key role in successful smoking reduction behavior (Berg, et al 2010; Tuten, et al 2012; Haug, et al 2014). However, with the exception of CBI participation, none of these studies specifically focused on women with opioid use disorders.…”