CASH INCENTIVE COULD HELP PREGNANT SMOKER QUIT

An OSU study of pregnant women finds that handing out vouchers can overcome
the urge for a cigarette

The carrot works better than the stick in persuading low-income pregnant
women to stop smoking.

That is the finding of a new study by researchers at Oregon State
University in Corvallis.

The study, made public Monday, found that low-income pregnant women were
far more likely to stop smoking if they were given vouchers worth $50 a
month than if they got only counseling and self-help literature.

Women who participated in the study were divided into two groups. The women
in the successful group also had friends or spouses who gave moral support
during the 10 months each woman was observed. The partners received
vouchers for $25 a month except for the first and last months, when they
received $50 vouchers.

After eight months of pregnancy, 34.6 percent of those who received
vouchers were still smoke-free, compared with 9 percent of those who did
not.

Two months after they delivered their children, 24 percent of those who
received vouchers were still smoke-free, compared with 5 percent of the
others.

The study, done over the last two years, has drawn the attention of the
U.S. Air Force which, like other military branches, is struggling with ways
to cut smoking. The study will be presented next Monday in a keynote speech
by researcher Susan L. Prows, an assistant professor of public health at
OSU, during the Air Force Worldwide Prevention Conference, sponsored by the
Air Force and the U.S. Surgeon General. Prows authored the study along with
Rebecca J. Donatelle, chair of the university's Department of Public Health.

The idea of paying people to do something that's good for their health has
raised some eyebrows.

"It's been somewhat politically controversial," Prows said. "A lot of
people say, 'People will quit if you just tell them how bad it is for
them.' But we've shown that's not true."

Bill Smith, manager of environmental health and tobacco control programs of
the American Lung Association of Oregon, called the results interesting.

But Smith wondered where a permanent program would find financial support.

"The findings are wonderful to see," he said. "But how are we going to fund
that kind of thing?"

Smith's opinion was echoed by Wendy Rankin, manager of the Multnomah County
tobacco reduction program.

"It's an interesting idea, but I think it's very expensive and I think
selling it be would politically tough," she said.

Prows thinks the cost of such a program would be more than offset by
savings in health care expenditures. The study, financed with a $240,000
grant from the Robert Wood Johnson Foundation, eventually will assess the
cost-effectiveness of the program.

If the program is shown to be worth the money, Prows said, she hopes the
study will be used to change the way society approaches the problem of
smoking.

Health costs associated with smoking are enormous. The Oregon Health
Division estimates that smoking was responsible for $267 million in medical
treatment in Oregon during 1993, the last year for which figures are
available. Death certificate information shows that in 1995, 6,274
Oregonians died from smoking-related causes -- 22.3 percent of all deaths
in the state.

Counted in the overall cost is treatment for children of smoking mothers.
Women who smoke during pregnancy are more likely than nonsmokers to bear
low birth-weight children. Prows said smoking causes 20 percent of all low
birth-weight deliveries. Each low birth-weight child generates $4,000 to
$9,000 in added medical expenses, she said.

In addition, she said, smoking is estimated to add 10 percent to the cost
of pediatric care.

Here's how the study worked: 220 pregnant women who agreed to participate
were divided into two groups. In one group, the women and their partners
received the vouchers, good for merchandise -- except tobacco and alcohol
- -- at Fred Meyer stores. They also received counseling and anti-smoking
literature.

The other group -- called the control group -- got only counseling and
literature.

Each month the women underwent saliva tests to determine if they really
were smoke-free.

A total of $50,000 for the vouchers came from private sources, most of
which have an interest in cutting smoking, Prows said. Among the donors
were Regence BlueCross and BlueShield of Oregon and HMO Oregon, Epitope
Inc., Fred Meyer Corp., Good Samaritan Hospital in Corvallis, Albany
General Hospital, and the March of Dimes.

The real innovation in the approach, Prows said, is that it avoids a
punitive approach to quitting smoking.

"We were interested in a positive approach and in the social support," she
said.

Other studies are planned to determine how important it is to have a caring
partner to lend support. Prows suspects that social support might be more
important than the financial incentive.