Diaper Vouchers Add Extra Incentive for Pregnant Women to Quit Smoking

It is not exactly cold hard cash, but don’t poo poo it. Free diapers are enough of an incentive to encourage pregnant women to quit smoking and stay quit.

Free diaper vouchers are a central component of the Baby & Me Tobacco Free program. The national smoking cessation program, which partners with local agencies, works to eliminate tobacco use by low-income, pregnant and postpartum women. The program has given out $700,000 worth of diapers nationwide over the past 10 years to approximately 5,700 women who have enrolled.

Smoking during pregnancy can lead to premature and low-birth weight babies, who are associated with an array of short and long-term health problems. Postpartum, secondhand smoke can have damaging health effects on babies as well. Even with these well-documented dangers, however, it is often difficult for expecting mothers to quit smoking.

“Our message at every point of contact is that quitting smoking is the most important thing you can do for the health of you and your baby,” says Laurie Adams, national executive director and founder of Baby & Me Tobacco Free. “That said, for our program to work, women need to agree to quit.”

The technique of motivational interviewing plays a role in helping women overcome their ambivalence to quit smoking and feel empowered to make an informed decision about going smoke-free. Once they do agree to quit, the program offers women the tools they need to be successful. This includes evidence-based change management skills, what to expect with withdrawal, problem solving second-hand smoke issues and help with stress management. And, the free diapers provide the extra push some women need.

How It Works

Typically, pregnant women are referred to the smoking cessation program by their physician, clinic, hospital or word of mouth. Women receive four prenatal counseling sessions and carbon monoxide (CO) monitoring. (Breath CO monitoring provides a way to verify self-reported claims of tobacco abstinence.) After the baby is born, the mother returns monthly for CO monitoring. Each time she is smoke-free, she receives a $25 diaper voucher to use at Walmart and/or a local participating store. Programs can run for 6 to 12 months postpartum, depending on available funding.

In some states, like Indiana, the program has enough funding to support more robust incentives. A participant can get diaper vouchers at two of the prenatal sessions if she has quit smoking. In addition, if the primary support person to the pregnant woman also quits, they receive diaper vouchers as well. Research has shown, community and family supports are essential for quitting and staying quit.

“We had a client who lived with her mother. They both quit, and our client had twins. They received four diaper vouchers a month postpartum,” says Adams. “There was also a 3-year-old child in the home who no longer had to be on asthma medication. This was a big win all around.”

Baby & Me Tobacco Free is currently active in 13 states and has a 60 percent quit rate at six months postpartum.

“The diaper vouchers have helped and are a great reminder of the work that went into quitting and staying quit,” says one 29-year old participant from Colorado, a smoker for 14 years. “I’m so happy I enrolled and I would recommend the program to anyone who is pregnant and smoking.”

Launching the Program at Your Center

The Baby & Me Tobacco Free program is intended to integrate into a local agency’s existing service roster. Interested sites participate in a training program and receive toolkits, outreach training, CO monitors, vouchers and ongoing monthly technical assistance.

For interested sites, Adams suggests the following:

• Find funding sources. There are many potential sources of funding, including grants, the Tobacco Master Settlement Agreement, the March of Dimes, the Maternal Child Health Bureau, private funding such as CVS and nonprofit agencies, and health insurances companies.
• Create a network of support. Go out and talk to doctors and other agencies and potential referral sources about the program.
• Get the state engaged. Work with existing programs like state quit smoking hotlines, or consider embedding prompts in state electronic medical records to refer smokers to the program, to have the most impact. 

To learn more about the program, visit www.babyandmetobaccofree.org