Examining Delay Discounting and Response to Incentive-Based Smoking-Cessation Treatment Among Pregnant Women

Delay discounting is considered by many to be a risk factor for substance use disorders and other health-related behavior problems. While these health-related behavior problems are often treated with incentive-based interventions, little is known about whether delay discounting (DD) moderates response to that treatment approach. The present study examined how response to incentive-based smoking-cessation treatment varied as a function of baseline DD scores among pregnant women participating in randomized controlled clinical trials examining the efficacy of financial incentives. Women were assigned to a condition wherein they earned vouchers exchangeable for retail items contingent on abstinence from recent smoking or to a control condition wherein they received vouchers of comparable value but independent of smoking status. Individual differences in DD of hypothetical monetary rewards were measured at the study intake and follow-up assessments. We examined whether individual differences in baseline scores on that instrument predict antepartum and postpartum smoking status using logistic regression, and if sustaining abstinence caused changes in DD scores from intake to 24-weeks postpartum. We did not see any significant main effects of DD or interactions of DD with treatment on antepartum or postpartum smoking status. Treatment condition, baseline smoking rate (cigs/day), a history of quit attempts pre-pregnancy, and educational attainment were all associated with increased odds of abstaining from smoking at the late-pregnancy antepartum assessment, and treatment condition was the only significant predictor of abstaining from smoking at 24-weeks postpartum, three months after the treatment formally ended. We saw no discernible evidence that sustained abstinence from smoking was associated with post-treatment decreases in DD. Overall, we saw no evidence that being a steeper discounter is associated with a lack of success in quitting smoking in either treatment condition. Being assigned to the incentives condition was the only predictor of antepartum and postpartum abstinence. The observed associations of a lower baseline smoking rate, higher educational attainment, and a history of having attempted to quit smoking previously with increased odds of success in achieving antepartum smoking abstinence is consistent with results from previous reports on predictors of response to this treatment underscoring the reliability of these relationships