Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Stephen T. Higgins


Introduction: Financial incentives increase smoking abstinence among pregnant and postpartum women. They have also been reported to reduce psychological symptoms using the Beck Depression Inventory (BDI) and Brief Symptom Inventory (BSI) in women at risk for perinatal depression. This prospective study aims to replicate and extend these findings using the BDI and Edinburgh Postpartum Depression Scale (EPDS). Methods: Participants were 169 pregnant cigarette smokers who were assigned to one of two treatment conditions: Best Practices only (n=88), which entails brief counseling and a referral to a pregnancy-specific quit-line, or Best Practices + Incentives (n=81). Participants were categorized as at increased risk (Dep+; n= 91) or lower risk (Dep-; n= 76) for depression based on history of depressive symptoms and baseline symptom scores. Treatment effects on smoking status and BDI/EPDS scores were examined across nine perinatal assessments using repeated measures analyses of covariance. Results: Financial incentives increased rates of biochemically-verified abstinence through 12-weeks postpartum independent of depression risk (ps ≤ .01) but did not differentially decrease BDI or EPDS scores (ps > .05). Scores decreased with both interventions for the Dep+ women (p = .001). Conclusions: These results replicate earlier evidence that financial incentives increase perinatal smoking abstinence in Dep+ women but not their efficacy in differentially reducing depressive symptoms at levels greater than Best Practices. The failure to replicate effects on depressive symptoms may be due to use of different control conditions in the current and prior study or increased screening and intervention for perinatal mental health during routine obstetrical care.



Number of Pages

78 p.