Randomised pilot trial of cash incentives for reducing paediatric asthmatic tobacco smoke exposures from maternal caregivers and members of their social network

Abstract

BackgroundThe primary aim was to evaluate the efficacy of financial incentives for reducing paediatric tobacco smoke exposures (TSEs) through motivating cigarette usage reduction among low-income maternal caregivers and members of their social network.DesignRandomised control pilot trial over a 6-month study follow-up time period. The study was undertaken from May 2017 to -May 2018. Once monthly follow-up visits occurred over the 6-month study period.SettingBaltimore City, Maryland, USA.ParticipantsWe grouped 135 participants into 45 triads (asthmatic child (2–12 years of age), maternal caregiver and social network member). Triads were assigned in a 1:1 allocation ratio. The maternal caregiver and social network members were active smokers and contributed to paediatric TSE.InterventionsTriads were randomised to receive either usual care (TSE education and quitline referrals) or usual care plus financial incentives. Cash incentives up to $1000 were earned by caregivers and designated social network participants. Incentives for either caregivers or social network participants were provided contingent on their individual reduction of tobacco usage measured by biomarkers of tobacco usage. Study visits occurred once a month during the 6-month trial.Main outcome measuresThe main outcome measure was mean change in monthly paediatric cotinine levels over 6 months of follow-up interval and was analysed on an intention-to-treat basis.ResultsThe mean change in monthly child cotinine values was not significantly different in the intervention cohort over the 6-month follow-up period, compared with the control group (p=0.098, CI −0.16 to 1.89). Trends in child cotinine could not be ascribed to caregivers or social network members. Despite decreasing mean monthly cotinine values, neither the intervention cohort’s caregivers (difference in slope (control–intervention)=3.30 ng/mL/month, CI −7.72 to 1.13, p=0.144) or paired social network members (difference in slope (control–intervention)=−1.59 ng/mL/month, CI −3.57 to 6.74, p=0.546) had significantly different cotinine levels than counterparts in the control group.ConclusionsFinancial incentives directed at adult contributors to paediatric TSE did not decrease child cotinine levels.Trial registration numberNCT03099811.

Patient financial incentives to improve asthma management: a systematic review

“…As detailed in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart25 (see figure 1), searches identified 4268 articles; 8 met the eligibility criteria 26–33…”

“…These are detailed in online supplemental material 2. Studies were conducted in the USA (n=7)26–30 32 33 and the UK (n=1) 31. There were five RCTs26–30 and three non-randomised studies 31–33.…”

“…Studies were conducted in the USA (n=7)26–30 32 33 and the UK (n=1) 31. There were five RCTs26–30 and three non-randomised studies 31–33. Three studies were theory-based 29 31 33.…”

“…Three studies were theory-based 29 31 33. Five studies provided financial incentives to patients with asthma,26 27 31–33 and three studies provided financial incentives to parents of CYP 28–30. There were data available for attendance at asthma-related appointments (n=4),26–29 tobacco smoke exposure (TSE) (n=1)30 and medication adherence (n=3) 31–33.…”

“…Four studies assessed ‘one-off’ behaviours (eg, attendance at one asthma-related appointment26–29), so longer-term behaviour change was not reported. However, two studies assessing medication adherence reported follow-up data after cessation of the financial incentives; neither demonstrated sustained behaviour change 29 30…”