No abstract

This study examined quit rates longitudinally for cigarettes, e-cigarettes, hookah, cigars, and all tobacco products in a U.S. national sample of women aged 18-44 who completed both Wave 1 (W1) and Wave 2 (W2) of the Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) study (N = 7814). Quit rates were examined among women who transitioned into pregnancy across survey waves, and among a comparable sample of non-pregnant women to provide contextual information about quitting among the broader population of reproductive-aged women. Multiple logistic regression modeling was used to estimate the associations of pregnancy and quitting adjusting for other demographic and psychosocial characteristics. Quit rates among women who were pregnant in W2 were highest for hookah (98.3%), followed by cigars (88.0%), e-cigarettes (81.3%), and lowest for tobacco cigarettes (53.4%). Slightly more than half (58.7%) of women reported quitting use all tobacco products while pregnant. Pregnancy was independently associated with increased odds of quitting hookah (AOR = 52.9, 95%CI = 3.4, 830.2), e-cigarettes (AOR = 21.0, 95%CI = 2.6, 170.3), all tobacco products (AOR = 9.6, 95%CI = 6.4, 14.5), and cigarettes (AOR = 6.5, 95%CI = 4.2, 10.1), although not cigars. Relative to other demographic and psychosocial characteristics, pregnancy was the strongest predictor of quitting use of each tobacco product. While these data indicate that pregnancy has strong, independent associations with quitting a variety of commercially available tobacco products, the comparatively lower quit rates for cigarettes versus other tobacco products underscores the long-standing need for more intensive, multipronged clinical and regulatory interventions to reduce cigarette use among reproductive-aged women.

Cigarette smoking during pregnancy can cause serious adverse pregnancy, birth, and longer-term health outcomes. 1,2 The most efficacious smoking cessation intervention for peripartum individuals is abstinence-contingent financial incentives (FIs), but there are challenges to scaling this intervention, including reaching individuals in geographically remote areas while retaining treatment efficacy. 3,4 To address that challenge, this study examined the efficacy of a smartphone-based intervention whereby smoking monitoring and incentive delivery was managed via a mobile app. MethodsThis randomized clinical trial included 90 pregnant individuals aged 18 years or older who were recruited nationally via social media; obstetrical clinics; and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offices between April 2019 and May 2020. The trial protocol appears in Supplement 1. The University of Vermont College of Medicine institutional review board approved this study, and all participants provided written informed consent. The study follows Consolidated Standards of Reporting Trials (CONSORT) reporting guidelines for trial studies (eFigure in Supplement 2). Participants were randomized to Best Practices (BP) alone or with FIs (BP with FI) (detailed previously). 5 Briefly, BP included brief counseling and a tobacco quit-line referral. BP with FI included BP plus an FI intervention in which smoking monitoring and incentive delivery were completed via smartphone app (DynamiCare Health Inc). Participants submitted videos of themselves conducting salivary cotinine tests remotely (Alere iScreen [New Line Medical]) and received autogenerated notifications detailing test results and associated earnings. Incentives were delivered from study start to 12 weeks post partum via a debit card using an escalating schedule (maximum earnings,

Background-Identifying predictors of tobacco use patterns that differ in harm among reproductive-aged women may inform efforts to protect women and children against adverse health impacts of tobacco use.Methods-Changes in tobacco use patterns were examined among women (18-49 years) who completed Wave 1 (W1) and Wave 2 (W2), or W2 and Wave 3 (W3) of the U.S. Population Assessment of Tobacco and Health (PATH, 2013-2016) study, and were using cigarettes, filtered cigars and/or cigarillos in the first wave over which data were included for that respondent (Time 1; T1). We examined the proportion of respondents whose tobacco use transitions from T1 to Time 2 (T2) were harm-maintaining (continued using combusted tobacco), harm-reducing (transitioned to electronic nicotine delivery systems (ENDS), or harm-eliminating (quit tobacco). Multinomial logistic regressions (with harm-maintaining as the baseline category) were conducted to examine associations between ENDS use, demographic, and psychosocial characteristics with each transition.

Women of reproductive age and particularly pregnant women underutilize evidence-based smoking cessation services such as counseling and quit lines. Mobile health (mHealth) may constitute an unexplored and innovative avenue for providing smoking cessation support to a population that is otherwise difficult to reach with evidence-based interventions. Female respondents aged 18–44 years (N = 10 023) were drawn from the first wave of the Population Assessment of Tobacco and Health (PATH) study (2013–2014). We examined prevalence of use of various digital forms of communication (e.g., social media, text messaging, smartphone ownership) among non-pregnant women of reproductive age, pregnant women, and among smokers versus non-smokers within these groups. Multiple logistic regression modeling was conducted to identify correlates of using each digital form adjusting for smoking status, pregnancy, and demographic characteristics. Over two thirds of women overall and within subgroups of non-pregnant and pregnant smokers reported using social media, owning a cell phone, owning a smartphone, downloading apps, and sending/receiving text messages. Current smokers and those with lower educational attainment generally had lower odds of using each digital form relative to non-smokers and those with higher educational attainment, the exception being that smokers had higher odds of using social media relative to non-smokers. The high prevalence of using various digital forms among both non-pregnant smokers of reproductive age and pregnant smokers suggests that leveraging technology to expand access to prevention, education, and treatment resources may reduce smoking-attributable adverse health effects among reproductive-aged women and their offspring.