Diaper Vouchers Add Extra Incentive for Pregnant Women to Quit Smoking

Posted September 22, 2015 by Cindy Hutter

Smoking Cessation In Pregnant Women

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.orgExternal Link

To learn more about NICHQ's infant health work, visit the infant health section of our website.


Add your comment





sickle cell disease SCD advocacy Baby-Friendly breastfeeding Pediatric journal Best Fed Beginnings infant health safe sleep IM CoIIN QI quality improvement flexibility family partner parent partner vision screening nichq perinatal quality measures sustainabilty preterm birth tips PDSA cycle baby box infant mortality family engagement eccs coiin immunizations health equity health disparities accreditation astho onboarding collaboration engagement partnerships larc nashp new york wic new york state hospitals mom mother partners epilepsy data AAP early childhood pdsas texas community support learning session children's health new technology engineering transgender collaborative learning planning PDSA planning paralysis underplanning analysis paralysis vision eye health smoking smoke-free housing second-hand smoke toolkit e-module dental care oral health underserved populations health inequity public health Maternal and Child Health Journal leadership engagement indiana medicaid perinatal regionalization sudden infant death syndrome national birth defects prevention month birth defects pregnancy planning one key question prepregnancy health preconception health public breastfeeding support families patients experts insights CHOPT childhood obesity innovation food desert telemedicine TBLC breastfeeding supporting prematurity racial disparities audiology ehdi follow-up illinois talana hughes vulnerable populations sports asthma soccer basketball obesity football SIDS Pokemon Go gamification smartphones interconception care birth spacing issue brief contraceptive use postpartum care CoIN HRSA early childhood trauma NHSA community health consumer advocacy womens health interconception health teenage health PATCH wisconsin missouri risk appropriate care community health workers SCD< infographic infant mortality awareness month inspirations childrens health national breastfeeding month maternal health patient engagement hearing loss hearing treatment pediatric vision eyesight pre-term birth early-term birth SCD clinic los angeles LOCATe CDC levels of care neonatal care maternal care smoking cessation project safe sleep practices neonatal abstinence syndrome NAS opioids maternal and child health MCH Family voices quality care mental health hydroxyurea SCDTDP men dads testing change data sharing state government city government apps sleep AJPM preconception care senior leadership breastfeeding support video series access BQIH exclusive breastfeeding long-acting reversible contraception unplanned pregnancies social determinants of health health innovations Best Babies Zone CoIIN baby boxes Rhode Island progesterone rooming-in patient and family engagement healthy weight healthy lifestyles primary care telementoring ECHO video conferencing socioemotional health childhood development pediatric Tennessee interview National Coordinating and Evaluation Center medical-legal partnerships mobile app disparities perinatal care overweight obese healthy weight clinic wellness pilot sites data collection education resources paternal engagement risk-appropriate care preterm infants high-risk babies Ten Steps public relations social movement reversible contraceptives medical home pediatric medical home patient transformation facilitator PTF skin-to-skin rooming in prenatal smoking information visualization charts SUID postpartum new mother webinar AMCHP QI Tips ongoing improvement fourth trimester partnership quality and safety coaching leadership support year end holiday message reflections gratitute Medicaid data doctor relationship PQC perinatal quality collaboratives vision care vision health evidence-based guidelines ASH health and wellness healthy living healthy eating home visitors home visiting programs March of Dimes APHA results evaluation supplementation formula reduction video infant loss social media leadership Berns Ten Steps to Successful Breastfeeding sustainability stress prenatal care data capacity epidemiologists surveillance data PFAC community partners preconception and interconception care motivational interviewing Native Americans ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit system design care coordination skin to skin newborn screening reduce smoking aim statement safe birth Texas Ten Step skin-to-skin contact 10 Steps staff training small tests acute care mother-baby couplet collective impact population health preconception Newborn Screening Program substance abuse breast milk formula milk bank crisis first responders NYC improvement healthcare health system sickle cell diease treatment protocol family health partner maternity care Collaborative Improvement and Innovation Network Health Outcomes Cross-Sector Collaboration Knowledge Sharing Child Health