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An experiment was conducted between 2016 and 2018 in France with pregnant women who smoke, offering them vouchers to quit smoking, with conclusive results. But is this incentive feasible in the long term? We talk about it with Dr. Ivan Berlin, at the origin of this experiment.
Finding the right method, the one that will make you quit smoking for a long time, is often a struggle among smokers, as among medical specialists. Finding the right trigger is even more urgent when smoking concerns a woman who is expecting a baby. It is in this context that new experiments are regularly launched, one of them plans to reward candidates for withdrawal. On October 20, Doctissimo relayed a Scottish study providing vouchers to women who planned to set a date to quit smoking and stick to it. A strategy already tested in France. In 2016, Dr Ivan Berlin from the pharmacology department of the Pitié-Salpêtrière AP-HP hospital also launched an experiment with 18 maternity wards by issuing vouchers to reward the abstinence of pregnant women and smokers. Can this type of incentive work?
4 times more likely to quit smoking thanks to vouchers
The French experiment, the results of which were published in December 2021 in the British Medical Journal shows above all that the notion of reward works on the will against smoking. “We have amazing results” describes the doctor specializing in addiction. “Our study was smaller than studies conducted in Britain, and squarer too. Our goal was to reward abstinence from the first trimester, not just the will to quit. At each appointment, participants could receive a voucher as long as they remained abstinent. Thanks to this, the probability of quitting smoking was found to be 4 times higher than without a reward”.
Lure of profit, gamification… Why does the reward work?
The question of motivation may then arise. Why did these women more easily put aside their cigarettes? For the doctor, the lure of profit is not necessarily the reason, despite the shortcut that can be made: “Experience does not really explain the reasons for success. But from a psychic point of view, the reward, whether in the form of food, vouchers or even drugs, activates the same mechanisms in the human brain. In the event of a reward, a neurobiological mechanism is set in motion. But the main thing here was to achieve a result, not to explain the whole process”.
Could the reward method be scaled up?
Although the conclusions of his study are largely positive, the doctor nevertheless strongly doubts the possibility of reproducing this method throughout an entire country, even recognizing a real “hassle” to set up a different system.
“The method works on pregnant women, but it doesn’t work from a public health perspective. The experiment was only possible thanks to the good will of the doctors and midwives involved. But there was no financial or organizational support, no will. I discovered that clinical research that can lead to changes in management is not currently supported.“ he regrets.
Quitting smoking for reward: is there a moral problem?
During the launch of his experiment, Dr. Berlin was also questioned about the morality involved. Should we give financial compensation to young women to quit smoking? Opinions for and against followed one another.
But for the doctor, the question is irrelevant: “First of all, we didn’t give money but good shopping vouchers, useful for pregnancy. But whatever the case, tobacco is so toxic during pregnancy, so toxic for the child, whether in utero and even after birth, that morality has no place. The benefit is there, in terms of disease, in terms of the good growth of the child. It’s all that matters”.