Hybrid human-digital motivational incentive intervention protocol for smoking cessation among perinatal Medicaid...

Cigarette smoking is a top cause of preventable morbidity and mortality that disproportionately impacts those covered by Medicaid. For pregnant individuals, tobacco exposure can lead to health concerns, including increased likelihood of preterm birth and low birth weight. Prior motivational incentive interventions have shown that pregnant individuals are more likely to achieve smoking abstinence, which improves infant health, when provided incentives. However, many interventions are limited by the burden of frequent in-person office visits. Hybrid human-digital interventions can balance the benefits of human-touch with the scalability and reach of digital health.

This paper outlines the protocol of a single-arm Perinatal Incentives2Quit program, herein Incentives2Quit-Peri, a hybrid human-digital motivational incentive intervention for smoking cessation. Incentives2Quit-Peri recruits patients through community-partnered clinical sites. Patients are paired with a coach who guides them through enrolling in the Incentives2Quit-Peri mobile app with an integrated carbon monoxide monitor, and in the Michigan Tobacco Quitlink phone program. Patients receive rewards (i.e., virtual or physical gift cards), for intervention engagement and smoking cessation. Building on promising pilot findings, and developed through community-centered design, Incentives2Quit-Peri aims to evaluate technical feasibility and program acceptability, and exploratory outcomes focused on smoking reduction, birthweight, and optimizing intervention engagement and cessation.

The Incentives2Quit-Peri program is a key step towards scalable, personalized motivational incentive programs to assist pregnant individuals in pursuing smoking cessation. Furthermore, this program serves as the basis for future programs tailored to varied populations facing tobacco-related health disparities.