A Smoking Resumption-Prevention Intervention for Pregnant Women

Pamela K. Pletsch , PhD, RN

The vast majority of women who stop smoking during pregnancy resume smoking postpartum. While epidemiologic studies have provided insight into the characteristics of women and their environments that are associated with resumption, efforts at relapse prevention have been disappointing. In this study we will: a) refine the risk assessment for postpartum smoking resumption that includes bio-behavioral, pregnancy-specific, and co-condition smoking risks, b)  assess the feasibility of using telephone counseling to deliver the intervention to this population, c) obtain a preliminary estimate of the magnitude of effect that the intervention has on 3-month postpartum smoking rates.

Smoking rates for women in the United States hover around 23%. Healthy People 2010 targets include increasing smoking cessation during pregnancy to 30% and reducing smoking by adults to 12%.  Prevention of smoking resumption postpartum will decrease the risk of tobacco-related health problems for women and children and reduce health care costs. A better understanding of processes that underlie behavior changes during pregnancy and postpartum and the development of interventions that are tailored to changes in motivation and life demands during this critical time will move the science forward in our efforts to improve women’s health.

The characteristics of women and their environments that are associated with smoking resumption are: a) degree of addiction, b) partner or household member smoking, c) socio-economic status, d) social support, e) self-efficacy for smoking abstinence, g) mental health, h) breast feeding plans and patterns, i) concerns for the baby’s health, and j) concerns for their own health. Variables that are amenable to change in response to an intervention are: smoking patterns, motivation for cessation, health concerns, support for non-smoking, self-efficacy, weight concerns, depression, and nicotine cravings. Our multi-modal risk assessment and subsequent tailored intervention will address this array of variables.

For this 1 year pilot study, we will refine the intervention with a sample of 10-15 pregnant women, age 18 or older, who have been continuously abstinent from cigarette smoking from 24-28 weeks of pregnancy, and are receiving prenatal care from University of Wisconsin Health Systems.  All new obstetric patient charts will be reviewed by clinic staff and women with a history of tobacco use will be contacted by a clinic health education nurse and informed of study availability. If women are interested in learning more about the study, they will be contacted by a study RA and screened for eligibility.  Women who want to enroll will be contacted by the nurse interventionist/case manager (CM) when women are between 28 and 32 weeks pregnant, confirm their non-smoking status, and make an appointment to explain the study further, obtain written informed consent, conduct the risk assessment, and collect baseline data. The first intervention contact will be in person and occur between 32-34 weeks. Additional intervention contacts will occur by telephone at 36 weeks of pregnancy and for 12 weeks postpartum. Follow up data will be collected at 12 weeks postpartum. Preparatory work includes refinement of the risk assessment which includes pregnancy-specific extrinsic motivators, tobacco and non-tobacco-related intrinsic motivators, and women’s expectations for resuming smoking postpartum. The intervention includes motivational interviewing, stage-matched counseling, referral for weight and depression management, and patient-centered decision-making. To obtain a preliminary estimate of the strength of the intervention, Chi square analysis will be used to compare the 12-week point prevalence smoking rates to rates in the literature and logistic regression will be used to assess the contribution of covariates. Thematic analysis will be conducted on the qualitative data. Ultimately, the telephone counseling will continue for 9 months postpartum, with assessments at 6 and 12 months. Due to the 1-year time limit of the pilot, only the pregnancy and first 3 postpartum intervention contacts will be delivered and the first postpartum assessment done.