Objective-The objective of this study was to evaluate a depression-focused treatment for smoking cessation in pregnant women, versus a time and contact health education control. We hypothesized that the depression-focused treatment would lead to improved abstinence and reduced depressive symptoms among women with high levels of depressive symptomatology. No significant main effects of treatment were hypothesized.Method-Pregnant smokers (N=257) were randomly assigned to a 10-week intensive depressionfocused intervention (Cognitive Behavioral Analysis System of Psychotherapy-CBASP) or to a time and contact control focused on health and wellness (HW); both included equivalent amounts of behavioral and motivational smoking cessation counseling. Fifty-four percent of the sample was African American; 37% met DSM-IV criteria for major depression; mean age (SD) was 25 (5.9) and women averaged 19.5 (8.5) weeks gestation at study entry. Ongoing symptoms of depression were measured using the Center for Epidemiological Studies Depression scale (CES-D).Results-The results showed that at 6-months posttreatment, women with higher levels of baseline depressive symptoms treated with CBASP had a higher probability of prolonged abstinence (F(1,253) =5.61, p=.02) and more improved depression (F(1,2620)=10.49, p=.001) than those treated with HW, whereas those with low baseline depression fared better in HW. The differences in abstinence were not retained at 6-months postpartum. Conclusions-The results suggest that pregnant women with high levels of depressive symptoms may benefit from a depression-focused treatment in terms of improved abstinence and depressive symptoms, both of which could have a combined positive effect on maternal and child health.Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/ccp NIH Public Access Pritchard, 1994;Solomon et al., 2006;Zhu & Valbo, 2002) as well as post-partum relapse . There is evidence that depression clusters with SES and other risk factors for persistent smoking during pregnancy, and that the clustering of such factors predicts smoking in a gradient fashion (Kahn, Certain, & Whitaker, 2002). That depression cooccurs with low SES is not surprising. Children who grow up with low SES parents are at two to three times greater risk for developing major depressive disorder (MDD) than those who grow up with parents of higher SES, even when parental MDD status is controlled (Ritsher, Warner, Johnson, & Dohrenwend, 2001;Gilman, Kawachi, Fitzmaurice, & Buka, 2002). Because persistent smoking du...

No abstract

Objective-To review the evidence base underlying recommended cessation counselling for pregnant women who smoke, as it applies to the steps identified in the Agency for Healthcare Research and Quality's publication, Treating tobacco use and dependence: a clinical practice guideline. Data sources-Secondary analysis of literature reviews and meta-analyses. Data synthesis-A brief cessation counselling session of 5-15 minutes, when delivered by a trained provider with the provision of pregnancy specific, self help materials, significantly increases rates of cessation among pregnant smokers. This low intensity intervention achieves a modest but clinically significant eVect on cessation rates, with an average risk ratio of 1.7 (95% confidence interval 1.3 to 2.2). There are five components of the recommended method-"ask, advise, assess, assist, and arrange". Conclusions-We recommend these evidence based procedures be adopted by all prenatal care providers. The use of this evidence based intervention is feasible in most oYce or clinic settings oVering prenatal care and can be implemented without inhibiting other important aspects of prenatal care or disrupting patient flow. If implemented widely, this approach has the potential to achieve an important reduction in a number of adverse maternal, infant, and pregnancy outcomes and to reduce associated, excess health care costs. (Tobacco Control 2000;9(Suppl III):iii80-iii84)

Objective-There is a growing body of knowledge about the pregnant smoker and what happens as she goes through the pregnancy and postpartum periods. This article reviews the process of smoking cessation in the context of pregnancy. Data sources-Epidemiological data, extant reviews of the literature, and current original research reports are used to examine characteristics of the women and of the change process for those women smokers who quit, stop, or modify their smoking during pregnancy and the postpartum period. Data synthesis-An analysis of the interaction of the process of smoking cessation with pregnancy was conducted to gain insight into the unique problems faced by the pregnant smoker and discover directions for intervention. Conclusions-Pregnancy and the postpartum period provide a window of opportunity to promote smoking cessation and smoke free families. Understanding obstacles and pathways for pregnancy and postpartum smoking cessation can guide implementation of eVective existing programs and development of new ones. Recommendations include promoting cessation before and at the beginning of pregnancy, increasing delivery of treatment early in pregnancy, helping spontaneous and intervention assisted quitters to remain tobacco free postpartum, aiding late pregnancy smokers, and involving the partner of the woman smoker.(Tobacco Control 2000;9(Suppl III):iii16-iii21)

Objective-Three of the Smoke-Free Families projects incorporated motivational interviewing (MI) into prenatal smoking cessation interventions. This paper describes the process involved in training healthcare providers to use MI and the issues encountered in implementing the protocols. Design-Health care providers at all three sites attended local training workshops in which they learned to apply the basics of MI to their study protocol. All sites followed a similar outline and schedule for training and monitoring. Settings-The MI interventions were delivered through home visits in Boston, Massachusetts; phone based counselling calls to patients' homes in Southern California; and in urban and rural prenatal clinics throughout East Texas. Participants-Public health nurse and social work case managers, who were already employed by health care agencies, delivered the MI interventions. Measures-Pre-and postintervention assessments and feedback from trainers and investigators at all three sites. Results-Providers were enthusiastic about the training workshops, which they rated as eVective in preparing them to deliver the intervention. Barriers to implementation included diYculty in contacting patients and competing demands on providers' time. Conclusions-Conducting initial training for providers is the first step in developing skills to deliver motivational interventions. Additional time and resources are needed for ongoing skill building and monitoring of intervention delivery. (Tobacco Control 2000;9(Suppl III) (KPSC), and the University of Texas-Houston School of Public Health (UT-H) discovered the similarities in their intervention designs and discussed the advantages and feasibility of coordinating training eVorts. Collaboration was facilitated by four members of the investigative teams with extensive experience in training practitioners to use MI. It was thought that by using the same trainers (or configurations thereof) to conduct training at all three sites, the three studies would benefit from an important degree of standardisation.The similarities and diVerences between study sites are presented in table 1. While nurses and/or social workers from participating agencies were trained to deliver the interventions at all three sites, the health care settings and primary work responsibilities diVered. The target participants also diVered in a number of ways, although all were pregnant smokers. For example, Dana Farber's Healthy Baby Program (HBP) trained public health nurses to deliver the intervention through in-home visits to low income women who lived in inner city and suburban areas in and around the Boston metropolitan area. The KPSC study used nurse case managers who worked in a regionwide preterm prevention program that monitored patients through phone based counselling. The UT-H providers were nurse or social worker case managers employed in 10 urban and rural prenatal care clinics throughout East Texas. Thus, at all three sites, the providers who delivered the intervention were employed by a par...