I recently wrote an article on how smoking affects pregnancy. It had all the usual facts. For instance, smoking may make it more difficult for a woman to become pregnant. But if she is able to get pregnant, the baby is more likely to have a lower birth weight (< 5.5 pounds), physical and developmental abnormalities, and a 2-3 times greater risk of sudden infant death syndrome (SIDS). I also spoke how woman are more likely to have excessive bleeding during delivery than if they were a non-smoker.
I believe everyone knows that smoking is bad. I also believe everyone knows that smoking is bad for your unborn child. And, I think everyone knows that smoking is bad for your nursing baby (both via the breast milk and secondhand smoke). But I don't know if everyone knows just how bad. For instance, if you approached a pregnant woman smoking and told her these facts listed above, would she be surprised or just roll her eyes and say, "I know, now leave me alone."Smoking cessation can be difficult for the average smoker, but now imagine a pregnant woman trying to stop smoking. She is probably a little stressed by her physical and soon to be environmental changes. Smoking may be a source of comfort for her during this time. So the question becomes, how do we help pregnant woman stop smoking? The answer seems to be: SHOPPING!
Not the answer you were expecting? Well hold on while I explain. Psychologists often utilize behavioral interventions which rearrange a person's environment to reinforce appropriate behavior patterns. At the same time, they provide negative reinforcement for inappropriate behaviors. These type of procedures have been used in those with substance-abuse problems. These behavioral interventions have been coined contingency management.
The concept of contingency management in smoking cessation is somewhat novel. In this situation, smoking cessation is reinforced when the smoker has a negative biochemical-marker test. So if the smoker's urine-cotinine level was below a threshold, they would receive a reward.
That leaves the question of "the reward", what should it be? In pregnant women who were smokers, they decided to use vouchers good at retail shops. In the group that was being managed, the voucher would increase every week as long as the biochemical verification was below the threshold. If it were elevated, the voucher amount would go back down, but could be returned to the higher level with two consecutive negative test results. The maximum voucher amount was $45. This group was then compared to a control group who was given a lower value voucher ($10-15). This second group did not have to submit to a biochemical verification requirement.
What they found was that 40% of the women in the contingency management group, were able to maintain smoking cessation throughout the pregnancy, compared to 10% in the control group. Interestingly, only 1 participant reported using a stop smoking aid during the study. That woman used nicotine gum during the first week of the study.
There was another point made by this study, the babies born to those who quit during the pregnancy were healthier. They were bigger and stronger and had a trend toward reaching full term than those born to the female smokers.
A follow up study looked at mom weight gain during the pregnancy after smoking cessation in this same type of contingency management study design, and found that the abstinent women did have higher weight gain, but it was attributed to the larger baby in utero, rather than some type of excessive weight gain due to smoking withdrawal, as is sometimes seen in smoking cessation.
So, obviously this type of contingency management treatment is effective at soliciting smoking cessation, but it can get very expensive. However, I believe this reveals a powerful influence in the world of smoking cessation. It seems that time and time again, if the reward is large enough, the person will quit smoking. This means we just need to paint the picture so the reward is easier to see. Too often we focus on the method to quit and not the reason. Ultimately, it's the reason that matters most.
