Evidence map›Paper›PMID 28728583›Full record

Trial reportTrials2017

Birth weight differences between those offered financial voucher incentives for verified smoking cessation and control participants enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), employing an intuitive approach and a Complier Average Causal Effects (CACE) analysis.

Alex McConnachie, Caroline Haig, Lesley Sinclair, Linda Bauld, David M Tappin

Abstract readComparative StudyRandomized Controlled Trial
In one paragraph

Trial report in Trials, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  3. Article
  4. Observational
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Alex McConnachieRobertson Centre, Level 11, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, UK.
Caroline HaigRobertson Centre, Level 11, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, UK.
Lesley SinclairInstitute for Social Marketing, Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, UK.
Linda BauldInstitute for Social Marketing, Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, UK.
David M TappinSection of Child Health, School of Medicine, Glasgow University, Scottish Cot Death Trust, 5th floor, West Glasgow Ambulatory Care Hospital, Yorkhill, Glasgow, G3 8SJ, UK. david.tappin@glasgow.ac.uk.

Funding

Chief Scientist Office CZH/4/594Medical Research Council MR/K023195/1
6 · The paper itself

Abstract

backgroundThe Cessation in Pregnancy Incentives Trial (CPIT), which offered financial incentives for smoking cessation during pregnancy showed a clinically and statistically significant improvement in cessation. However, infant birth weight was not seen to be affected. This study re-examines birth weight using an intuitive and a complier average causal effects (CACE) method to uncover important information missed by intention-to-treat analysis.

methodsCPIT offered financial incentives up to £400 to pregnant smokers to quit. With incentives, 68 women (23.1%) were confirmed non-smokers at primary outcome, compared to 25 (8.7%) without incentives, a difference of 14.3% (Fisher test, p < 0.0001). For this analysis, randomised groups were split into three theoretical sub-groups: independent quitters - quit without incentives, hardened smokers - could not quit even with incentives and potential quitters - required the addition of financial incentives to quit. Viewed in this way, the overall birth weight gain with incentives is attributable only to potential quitters. We compared an intuitive approach to a CACE analysis.

resultsMean birth weight of potential quitters in the incentives intervention group (who therefore quit) was 3338 g compared with potential quitters in the control group (who did not quit) 3193 g. The difference attributable to incentives, was 3338 - 3193 = 145 g (95% CI -617, +803). The mean difference in birth weight between the intervention and control groups was 21 g, and the difference in the proportion who managed to quit was 14.3%. Since the intervention consisted of the offer of incentives to quit smoking, the intervention was received by all women in the intervention group. However, "compliance" was successfully quitting with incentives, and the CACE analysis yielded an identical result, causal birth weight increase 21 g ÷ 0.143 = 145 g.

conclusionsPolicy makers have great difficulty giving pregnant women money to stop smoking. This study indicates that a small clinically insignificant improvement in average birth weight is likely to hide an important clinically significant increase in infants born to pregnant smokers who want to stop but cannot achieve smoking cessation without the addition of financial voucher incentives.

trial registrationISRCTN Registry, ISRCTN87508788 . Registered on 1 September 2011.

Indexed as

Birth WeightHealth BehaviorInfant, Low Birth WeightSmokingToken EconomyFemaleHealth Knowledge, Attitudes, PracticeHumansIntention to Treat AnalysisMothersMotivationPregnancyPregnancy ComplicationsPrenatal CareResearch DesignRisk FactorsBirth weightPregnancySmoking cessationTreatment effectiveness

Identifiers

PMID28728583
PMCPMC5520300

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.