Evaluation of a smoking cessation intervention for pregnant women in an urban prenatal clinic

Abstract

A smoking cessation and relapse prevention intervention was tested in an urban, prenatal clinic serving predominantly low-income, African-American women. At their first prenatal visit, 391 smokers were randomly assigned to an experimental (E) group to receive usual clinic information plus a prenatal and postpartum intervention or to a control (C) group to receive only usual clinic information. The intervention consisted of individual skills instruction and counseling by a peer health counselor on the use of a self-help cessation guide and routine clinic reinforcement. Among the E group (n = 193), 6.2% were cotinine-confirmed quitters at third trimester and among the C group (n = 198) the quit rate was 5.6%. Quitters were light smokers at entry into prenatal care. Many had tried to quit smoking at least once prior to pregnancy.

Smoking Cessation in Pregnancy: A Review of Postpartum Relapse Prevention Strategies

“…5 Successful quitters tend to be light to moderate smokers, 5,6 white, married, young, and educated. 32,33 When Edwards and Sims-Jones 34 interviewed 22 women who smoked before pregnancy and had relapsed postpartum, 3 themes emerged: pregnancy as a context for stopping smoking, specific events and stressors that precipitated a return to smoking, and social influences on smoking behavior.…”

“…41 Many programs have piggybacked with programs such as Women, Infants, and Children; Medicaid; health maintenance organizations (HMOs), and other organized, standardized, prenatal programs. 6,42,43 Some people have tried more unusual methods of reaching pregnant smokers, for example through videotape, 42 digitally interactive programs, 38 and peer telephone support. 30 Most of these programs have combined intervention strategies, hoping to increase success rates.…”

“…23,24 Although intervention programs that seem effective at preventing postpartum relapse are similar to those that encourage cessation, key differences exist. Programs that successfully reduce postpartum relapse rates, even though they are specifically designed to reduce prepartum smoking rates, are those that include the smoking habits of partners, others living in the home, and close friends; 6,31 support women with positive encouragement rather than negative nagging; 6,24 understand the time and financial commitment successful cessation interventions require; 23 encourage women's social networks to support her; 31 take place throughout pregnancy 31 and through early childhood care; 15 and distinguish between women with concrete plans for not relapsing and those who have not thought out possible challenges. 6 Several themes are elaborated on in studies focusing solely on prevention of postpartum relapse.…”

“…Between 29% and 85% of women who get a planned intervention relapse after delivery. [5][6][7][8][9][10][11][12][13][14][15][16] Although there is much information on why and how pregnant women should quit, fewer data exist on how to prevent relapse. This article is a literature review on relapse and relapse prevention in pregnancy; we looked at existing research, current strategies, and directions for future research.…”

Do changes in mood and concerns about weight relate to smoking relapse in the postpartum period?

“…As summarized in Table 1, information about relapse prevention has been presented during obstetrical visits (Gielen et al, 1997;McBride et al, 1999;Secker-Walker et al, 1995;1998), in the hospital following delivery , and during pediatrician visits Severson et al, 1997;Van't Hof et al, 2000). The interventions have involved selfhelp booklets and videos presented prior to delivery (McBride et al, 1999) or in pediatric offices (Severson et al, 1997;Van't Hof et al, 2000), advice presented during routine prenatal visits (Secker-Walker et al, 1995;1998), and relapse prevention counseling delivered by a nurse Ratner et al, 2000;Van't Hof et al, 2000) or a peer counselor trained for the study (Gielen et al, 1997).…”