Pictured above: Graphic features three screen captures from a smartphone depicting different features of the DynamiCare Health app used in the study.

Over the past several decades, numerous research studies have linked cigarette smoking to adverse health outcomes during pregnancy, birth and over the long-term for both babies and pregnant individuals. While research has proven that smoking cessation strategies incorporating abstinence-contingent financial incentives are most successful, this strategy has been difficult to deliver for those unable to access clinic-based locations.

A new study, led by University of Vermont Center on Behavior and Health (VCBH) researchers and colleagues and published in JAMA Network Open, found that using a smartphone app (DynamiCare Health Inc.) that monitored smoking and delivered incentives to participants’ debit cards showed promise in achieving similar results to traditional best practices with financial incentives.

The study included 90 pregnant individuals aged 18 years or older from across 33 states who were recruited between April 2019 and May 2020. Participants were randomized to receive either “Best Practices” (BP) treatment featuring brief counseling and a tobacco quit line referral or BP with a financial incentives (FI) intervention delivered via a smartphone app. Participants submitted videos of themselves conducting salivary tests remotely and received auto generated notifications detailing test results and associated earnings. Incentives were delivered via a debit card from the start of the study to 12 weeks postpartum and used an escalating schedule with maximum earnings of $1,620.

Results showed that individuals assigned to receive BP with FI had nearly four-fold greater odds of smoking abstinence across assessments conducted during pregnancy and following childbirth in comparison to individuals receiving standard best practice care. These results are consistent with meta-analyses showing incentives are the most effective intervention for pregnant smokers and provides seminal evidence that this intervention can be delivered remotely as effectively as clinic-based settings.

The study authors write that these findings pave the way “to expand the reach of this intervention to a broader swath of peripartum individuals, including those with socioeconomic disadvantage, rural residents, Indigenous individuals, and other racial and ethnic minority individuals.”

Study authors include first author Allison Kurti, Ph.D., former UVM assistant professor of psychiatry; former UVM postdoctoral fellows Tyler Nighbor, Ph.D., and Hypatia Bolívar, Ph.D.; Katherine Tang, Class of 2023 medical student; Carolyn Evemy, M.A., experimental psychology doctoral student and predoctoral fellow; Joan Skelly, M.S., research statistician; and senior author Stephen Higgins, Ph.D., VCBH director and Donaldson Professor of Psychiatry.