Disadvantaged women begin smoking at an earlier age, are heavier smokers and are more likely to be nicotine dependent and to fail at smoking cessation. When they become pregnant and have children, the behavior doesn’t change. In fact, almost 85 percent of U.S. children from low-income families are chronically exposed to secondhand smoke – especially from maternal smoking. A new five-year, $3.6 million grant from the National Institute on Child Health and Human Development awarded to the Vermont Center on Behavior and Health (VCBH) at the University of Vermont hopes to change that.

VCBH Director Stephen Higgins, Ph.D., will lead the project, which aims to study 250 economically disadvantaged mothers of young children (age 11 and under) in an effort to help them quit smoking and decrease secondhand smoke exposure among their children. The study will be based in the conceptual framework of behavioral economics – using financial incentives to motivate behavior change. Researchers at the VCBH will conduct a randomized controlled clinical trial comparing:

• Usual care for smoking cessation and reducing secondhand smoke exposure among children:
• Usual care combined with financial incentives for objectively verified smoking abstinence: and,
• Usual care combined with financial incentives and also with nicotine replacement therapy (NRT) using innovative procedures to enhance medication efficacy. 

“Overall, the proposed study has the potential to advance knowledge on efficacious, cost-effective smoking cessation for maternal smokers and protection against secondhand smoke exposure in children,” explains Higgins, the Virginia Donaldson, M.D.'51 Professor in the Department of Psychiatry, who has 30 years of experience in the field of addiction research. “The study also has the potential to impact policies and clinical practices regarding recommended care for combating chronic secondhand smoke exposure in disadvantaged children.”

Smoking among women is highly associated with socioeconomic status and is a direct contributor to health disparities. Smoking prevalence in the United States exceeds 30 percent among women with fewer than 12 years of education compared to less than 6 percent for women with graduate degrees. Smoking prevalence among disadvantaged mothers is at strikingly high levels of 40 to 60 percent.

Disadvantaged women are also at increased risk for smoking-related adverse health outcomes, including adversely impacting the health of their children through in-utero and secondhand smoke exposure. Secondhand smoke exposure increases risk for infant death, chronic respiratory infections, asthma and is estimated to increase direct medical and life-lost costs in the U.S. by nearly $5 billion annually.