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Smoking cessation interventions have posed significant challenges for health professionals, particularly when directed at high risk, low income, pregnant smokers. Typical quit rates for pregnant women who receive publicly financed obstetrical care have rarely exceeded 12–16%.1 As many as 70% of women who quit smoking during pregnancy relapse within one year of delivery.2 Two areas that have received particular attention as possible adjuncts to behaviour change are the use of reinforcements and social supports. Reinforcement in the form of incentives/rewards for positive behaviours has been controversial as an intervention strategy. Some argue that the “overjustification effect” of external rewards may cause subjects to lose internal motivation to modify behaviour over the long term.3 However, results of several studies, including two meta-analyses on reinforcement, provide compelling evidence that positive reinforcement provides positive behavioural changes.4-8
A second area of study that has been explored in the behaviour change research is the role of social support in motivating and sustaining selected behaviour change. Recent studies have empirically linked tobacco quit rates with daily interaction with a supportive “other,” preferably one who did not smoke.9 10
The primary objective of our intervention was to determine whether the combination of bolstered social support and financial incentives had an effect in significantly reducing smoking behaviour among low income, high risk, pregnant and postpartum women who participate in Oregon's Women, Infants, and Children (WIC) program.
The Significant Other Supporter (SOS) program was a randomised, experimentally designed smoking cessation study implemented in four Oregon WIC program sites. Criteria for entry into the study included the following: age 15 years or older; self reported smoker (“even a puff in the last seven days”); English speaker/reader; WIC eligible; and 28 weeks gestation or less. Eligible subjects were randomised into one of two groups, and were …