Efficacy of a Texting Program to Promote Cessation Among Pregnant Smokers: A Randomized Control Trial

Abstract

Introduction Smoking during pregnancy poses serious risks to baby and mother. Few disseminable programs exist to help pregnant women quit or reduce their smoking. We hypothesized that an SMS text-delivered scheduled gradual reduction (SGR) program plus support texts would outperform SMS support messages alone. Methods We recruited 314 pregnant women from 14 prenatal clinics. Half of the women received theory-based support messages throughout their pregnancy to promote cessation and prevent relapse. The other half received the support messages plus alert texts that gradually reduced their smoking more than 3–5 weeks. We conducted surveys at baseline, end of pregnancy, and 3 months postpartum. Our primary outcome was biochemically validated 7-day point prevalence abstinence at late pregnancy. Our secondary outcome was reduction in cigarettes per day. Results Adherence to the SGR was adequate with 70% responding to alert texts to smoke within 60 minutes. Women in both arms quit smoking at the same rate (9%–12%). Women also significantly reduced their smoking from baseline to the end of pregnancy from nine cigarettes to four; we found no arm differences in reduction. Conclusions Support text messages alone produced significant quit rates above naturally occurring quitting. SGR did not add significantly to helping women quit or reduce. Sending support messages can reach many women and is low-cost. More obstetric providers might consider having patients who smoke sign up for free texting programs to help them quit. Implications A disseminable texting program helped some pregnant women quit smoking. Clinical Trial Registration number: NCT01995097.

Trajectories of Situational Temptations in Pregnant Smokers participating in a Scheduled Gradual Reduction Cessation Trial

“…Given the theoretical underpinnings of the SGR reduction intervention, we hypothesized that the SGR intervention would help women break habitual cues and associated cravings leading to an increase in cessation compared to the control group. However, we found no arm differences in our trial (Pollak et al, 2020). Thus, we were interested in a secondary analysis of whether the intervention truly helped reduce situational temptations to smoke due to breaking associated cues.…”

“…This is a secondary, post-hoc analysis of the Baby Steps Trial, a randomized controlled trial(RCT) to compare the efficacy of an SGR plus text-based support messages intervention to a support text-messages only intervention in promoting smoking cessation in pregnant women from 2014 to 2017 (see Pollak et al, 2020 for full study details). This study was approved by the Duke University School of Medicine Institutional Review Board.…”

“…Women received 1-2 messages a day for the first 6 weeks and then three messages a week for the reminder of the study period. Messages were based on constructs of the Social Cognitive Theory and are described in more detail previously (Pollak et al, 2020). Women received the aforementioned support messages and a personalized smoking reduction calculated from baseline smoking patterns in the SGR arm.…”

“…Age, race and ethnicity, highest level of education, relationship status and employment status, and financial burden were assessed using self-report surveys. Refer to the main RCT paper for further details on validation of these measures (Pollak et al, 2020). These measures were collected at baseline.…”

“…In our recent randomized trial, we examined the effects of an SMS text-based scheduled gradual reduction (SGR) intervention compared to a control, a traditional abrupt cessation approach that included a text-based cognitive behavioral intervention on both smoking cessation and reduction. SGR consists of providing women with individualized smoking reduction schedules developed from baseline smoking data (Cinciripini et al, 1995;Pollak et al, 2020). We alerted women via text when to smoke over a 3-4 week period until their planned quit date.…”