Voucher scheme highly effective at helping stop smoking in pregnancy, study finds

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Pregnant woman gives up smoking.

A high street voucher scheme is highly effective in helping women stop smoking during pregnancy, according to new research involving the University of Stirling.

In a new UK-wide study – led by the University of Glasgow in collaboration with Stirling, the Universities of Edinburgh and York, and Queen's University Belfast – the addition of a Love2Shop voucher incentive scheme alongside regular UK Stop Smoking Services was shown to more than double the number of women who stopped smoking during pregnancy.

Published in the BMJ, the phase three randomised trial examined the effectiveness and the cost-effectiveness of adding an incentive of up to £400 of high street vouchers to existing prenatal care, aimed at helping women to stop smoking in pregnancy. Almost 1,000 pregnant women who were smokers were recruited to the trial, with half receiving standard Stop Smoking Services care and the other half the same prenatal care with the addition of the incentive scheme for smoking cessation.

Researchers found that 26.8% of pregnant women quit smoking by the end of their pregnancy from the group which included the addition of the voucher incentive, compared to 12.3% of the control group, which received only the standard Stop Smoking Services care.

Jennifer McKell, of the University of Stirling

Jennifer McKell, of the Faculty of Health Sciences and Sport, led the Stirling aspect of the study.

Maternal smoking is responsible for significant ill health and death among women and their children, including 7% of childhood hospital admissions for respiratory infection, 20% of infant deaths and 30% of babies born underweight. Research has shown that women who permanently quit smoking during pregnancy will go on to have a near normal lifespan, whereas women who continue to smoke in pregnancy and beyond are likely to lose up to 10 years of life.

The study took place at seven different sites across the UK – in Scotland, England, and Northern Ireland – and confirmed results through nicotine saliva testing. The participants were tested for smoking status between week 34 and week 38 of pregnancy. Most of the pregnant women who quit from both groups relapsed after their baby was born.

Research is ongoing, led by Professor Michael Ussher with Ms Jennifer McKell, of the University of Stirling’s Institute for Social Marketing and Health, to extend support, with financial voucher incentives, for 12 months after the baby is born, to see if mothers remain non-smokers ‘permanently’ benefitting both parent and child health.

Highly effective

Professor David Tappin, lead author of the study from the University of Glasgow, said: “We know that smoking in pregnancy can cause significant health problems for both mother and baby. Through this study, we have shown that the offer of high street vouchers, when offered in tandem with the current UK Stop Smoking Services, is highly effective at more than doubling smoking cessation during pregnancy, with a reduction in NHS costs over the long term.

Jennifer McKell led the Stirling aspect of the research, working alongside Professor Pat Hoddinott, of the Nursing, Midwifery and Allied Health Professions Research Unit. The Stirling element of the study focused on collecting and analysing mixed methods quantitative and qualitative data about prenatal care and trial processes at sites to understand the implications for practice and service delivery of the trial results. This process evaluation enables the team to understand how generalisable the findings are to different Smoking Support Service configurations working with maternity care services and, ultimately, informing how the scheme could be widened out and applied in other healthcare settings.

Ms McKell said: “Our team looked at how Stop Smoking Services care varied across the trial sites – examining the different types and characteristics of Stop Smoking Services offered to pregnant smokers and how they integrate with prenatal maternity services.

“We are hopeful our work will help health professionals caring for pregnant women and healthcare managers across the UK understand how the introduction of a voucher incentive scheme alongside Stop Smoking Services in their own healthcare settings can support pregnant women to stop smoking.”


The number of women who smoke in pregnancy has been declining in countries, including the UK and America, in recent years. In Scotland, between 1995 and 2019 self-reported smoking among pregnant women declined from 30.5% to 14.6% – a decline that was matched with falls in the rates of miscarriages and small births.

Despite progress in helping pregnant women to stop smoking, there is evidence that engagement with smoking cessation services is variable. Interventions using financial incentives, to encourage better engagement with stop smoking services, were initially piloted in the United States and led to the development of this phase three trial in the UK.

Professor Linda Bauld, joint principal investigator for the study from the University of Edinburgh, said: “Our study shows just how effective high street vouchers are as a quitting aid when added to stop smoking service support. This kind of intervention is about prevention, spending up front to avoid much more serious and costly health problems for the baby and the Mum if she continues to smoke.”

The paper, ‘Financial voucher incentives provided with UK Stop Smoking Services for pregnant women: a phase III Randomised Controlled Trial’, is published in The BMJ.

The study was funded by Cancer Research UK, the Scottish Government Chief Scientist Office, HSC Public Health Agency Northern Ireland, HSC R&D Division NI, Chest Heart and Stroke Northern Ireland, The Scottish Cot Death Trust and The Lullaby Trust.

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