Contingency management versus psychotherapy for prenatal smoking cessation: a meta-analysis of randomized controlled trials.
Open accessAbstract
Objective: Prenatal smoking is the leading preventable cause of poor obstetric outcomes, yet treatment options are limited. Past reviews of prenatal smoking cessation have often grouped all counseling into a single category, which ignores the fact that psychotherapy is distinct from brief counseling. The objective of this study was to compare the effect sizes of two intensive interventions for prenatal smoking cessation: contingency management (i.e., financial incentives for abstinence) and psychotherapy. Methods: A systematic search for randomized controlled trials testing the efficacy of contingency management or psychotherapy was completed using PubMed, PsycINFO, Web of Science, the Cochrane Library, and EMBASE. Independent raters extracted data and assessed trials for risk of bias. Treatment effects were analyzed for three times points: late pregnancy, early postpartum, and late postpartum. Results: The search yielded 22 studies, and meta-analytic results indicated that interventions (compared to control) generally increased the odds of abstinence. Moderator analyses indicated that intervention type (contingency management versus psychotherapy) accounted for variability in effect sizes. When comparing treatment type, effects of contingency management interventions were significantly larger than those of psychotherapeutic interventions. While psychotherapy did not affect smoking abstinence, contingency management interventions had significant treatment effects at all three time points. Conclusions: Contingency management appears to be a safe and efficacious prenatal smoking cessation treatment. Although psychotherapy alone did not show an effect on prenatal smoking abstinence, future research may seek to combine this approach with contingency management to promote prenatal smoking cessation.
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Compared with various controls, behavioral interventions such as in-person advice and support from clinicians; individual- and group-based, telephone and mobile phone-based support; interactive and tailored internet-based interventions; and the use of incentives were associated with increased relative smoking cessation at 6 or more months (15% to 88% range of relative effects).
“Compared with various controls, behavioral interventions such as in-person advice and support from clinicians;[50](#R50),[56](#R56) individual-[34](#R34) and group-based[57](#R57), telephone[41](#R41) and mobile phone-based support;[69](#R69) interactive and tailored internet-based interventions;[60](#R60) and the use of incentives[47](#R47) were associated with increased relative smoking cess”
From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [50]
The Results (Meta-Analytic Comparison of Intervention Strategies; page unavailable) report that incentive-based interventions significantly increased smoking-abstinence odds at all three measured time points. Methods (Data Extraction; page unavailable) define late postpartum as at least six months after delivery. The source studies pregnant women and reports odds ratios, not the claimed 15%–88% range of relative effects; it does not establish that range for incentives. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSmoking cessation advice from a nurse was associated with a pooled RR of 1.29 (95% CI, 1.21 to 1.38; 44 trials; n=20,881).
“For example, smoking cessation advice from a physician or nurse was associated with pooled RRs of 1.76 (95% CI, 1.58 to 1.96; 28 trials; n=22,239)[56](#R56) and 1.29 (95% CI, 1.21 to 1.38; 44 trials; n=20,881)[50](#R50), respectively.”
From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [50]
The Results (Systematic Search; page unavailable) report a meta-analysis of 22 prenatal smoking-cessation studies, while the Methods (Trial Selection; page unavailable) say brief advice encounters were excluded. Searches for the stated RR, confidence interval, trial count, and nurse-delivered advice found no passage reporting the attributed estimate. (LLM, conf=0.78)
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- Authors
- Wilson, S. M., Newins, A. R., Medenblik, A. M., Kimbrel, N. A., Dedert, E. A., Hicks, T. A., Neal, L. C., Beckham, J. C., & Calhoun, P. S.
- Affiliations
- Duke University (US)
- University of Central Florida (US)
- Virginia Commonwealth University (US)
- Corresponding author
- Wilson, Sarah M.
- ORCID
- Venue
- Women's Health Issues
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 28
- Issue
- 6
- Pages
- 514-523
- ISSN
- 1049-3867 (ISSN-L)
- PMC
- PMC6215492
- OpenAlex
- W2884703701
- Semantic Scholar
- 789561471b79df92a69af7ee63ad449f455bd053
- Cited by
- 20
- References
- 60
- Citations by year
- 2026: 2 · 2023: 6 · 2022: 2 · 2021: 2 · 2020: 6 · 2019: 1 · 2018: 1
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Women s Health Issues (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Journal of International Crisis and Risk Communication Research (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK2CX000718, IK2HX002398, IK6 BX003777, IK2CX000525)
- National Institute of Mental Health (R25MH083620)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- contingency management, financial incentives, psychotherapy, smoking abstinence, pregnancy, postpartum period, brief counseling
- MeSH terms
- Tobacco Smoking, Counseling, Female, Humans, Motivation, Pregnancy, Prenatal Care, Psychotherapy, Smoking, Randomized Controlled Trials as Topic, Smoking Cessation, Pregnant People
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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