JMIR Publications

ABSTRACT

Background:

Smoking rates among low-income individuals, including those eligible for Medicaid, have not shown the same decrease that is seen in high-income individuals. Rates of smoking among pregnant women enrolled in Medicaid are almost twice that of privately-insured women, which leads to significant disparities in birth outcomes and a disproportionate cost burden placed on Medicaid. Several states have identified maternal smoking as a key target for improving birth outcomes and reducing health care expenditures; however, efficacious, cost-effective and feasible cessation programs have been elusive.

Objective:

To examine the feasibility, acceptability, and effectiveness of a smartwatch-enabled, incentives-based, smoking cessation program for Medicaid-eligible pregnant smokers.

Methods:

Pilot 1: A randomized pilot study of smartwatch-enabled remote monitoring vs. no remote monitoring for 12 weeks. Those in the intervention group also received the SmokeBeat™ program. Pilot 2: A randomized pilot study of Pay-to-Wear vs. Pay-to-Quit for 4 weeks. Those in Pay-to-Wear could earn daily incentives for wearing the smartwatch, those in Pay-to-Quit could earn daily incentives if they both wore the smartwatch and abstained from smoking. Pilot 3: Similar to Pilot 2 with higher incentives, and a 3-week duration.

Results:

Pilot 1 (N=27): Self-reported cigarettes per week among the intervention group declined by 15.1 (SD = 27) cigarettes over the study; a similar reduction was seen in the control group with a decrease of 17.2 (SD = 19) cigarettes. Pilot 2 (N=8): Self-reported cigarettes per week among the Pay-to-Wear group decreased by 43 cigarettes; a similar reduction was seen in the Pay-to-Quit group with an average of 31 fewer cigarettes smoked per week. Pilot 3 (N = 4): One participant in the Pay-to-Quit group abstained from smoking for the full study duration and received full incentives.

Conclusions:

Decreases in smoking were seen in both control and intervention groups during all pilots. Use of the SmokeBeat™ program did not significantly improve cessation. The SmokeBeat™ program, remote cotinine testing, and remote delivery of financial incentives were considered feasible and acceptable. Implementation challenges remain for providing evidence-based cessation incentives to low-income pregnant smokers. Feasibility and acceptability of the SmokeBeat™ program were moderately high. Feasibility and acceptability of remote cotinine testing and remotely-delivered contingent financial incentives were successful. Clinical Trial: ClinicalTrials.gov NCT03209557, Registered 6 July 2017, https://clinicaltrials.gov/ct2/show/NCT03209557?term=smokebeat&draw=2&rank=1