Article Text

Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public
  1. Pat Hoddinott1,
  2. Heather Morgan2,
  3. Graeme MacLennan2,
  4. Kate Sewel3,
  5. Gill Thomson4,
  6. Linda Bauld5,
  7. Deokhee Yi6,
  8. Anne Ludbrook6,
  9. Marion K Campbell2
  1. 1Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
  2. 2Health Services Research Unit, University of Aberdeen, Aberdeen, UK
  3. 3Ipsos MORI Scotland, Edinburgh, UK
  4. 4Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
  5. 5Health Policy and Social Marketing, University of Stirling, Stirling, UK
  6. 6Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Pat Hoddinott; p.m.hoddinott{at}


Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design.

Design Cross-sectional survey.

Setting and participants British general public.

Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models.

Results Agreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%).

Conclusions Women and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic groups are required prior to implementing incentive interventions.

Trial registration number CRD42012001980.

  • Preventive Medicine
  • PUblic Health
  • Social Medicine

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