A Randomized Trial of Computer-Delivered Brief Intervention and Low-Intensity Contingency Management for Smoking During Pregnancy

Abstract

it could greatly increase the proportion of pregnant smokers who receive an evidence-based brief intervention. IntroductionSmoking during pregnancy has long been associated with adverse fetal outcomes. For example, smoking during pregnancy has been linked to fetal growth retardation, with estimates suggesting that 20%-30% of all cases of low birth weight can be attributed to prenatal tobacco exposure (Andres & Day, 2000). Increasing evidence also suggests that prenatal exposure to tobacco is associated with a range of additional risks from sudden infant death syndrome to long-term cognitive and behavioral deficits (e.g., Ness et al., 1999;Shea & Steiner, 2008;Stroud et al., 2009).A range of intervention approaches has been found to be efficacious in promoting smoking cessation. Among these are brief intervention approaches, which were supported in the most recent Clinical Practice Guidelines on smoking cessation (Fiore et al., 2008). Brief interventions are associated with small but clear increases in smoking cessation (Heckman, Egleston, & Hofmann, 2010;Hettema & Hendricks, 2010;Lai, Cahill, Qin, & Tang, 2010), including among pregnant women (Ferreira-Borges, 2005;Melvin, Dolan-Mullen, Windsor, Whiteside, & Goldenberg, 2000;Mullen, 1999;Pbert et al., 2004). Despite its small effects, the brief nature and primary care application of brief approaches means that they can theoretically be presented to a relatively large proportion of women who smoke during pregnancy, giving it the potential for high population impact.Contingency management (CM), in contrast, consistently yields strong effects but requires more effort and resources than Abstract Introduction: Implementation of evidence-based interventions for smoking during pregnancy is challenging. We developed 2 highly replicable interventions for smoking during pregnancy: (a) a computer-delivered 5As-based brief intervention (CD-5As) and (b) a computer-assisted, simplified, and low-intensity contingency management (CM-Lite). Methods:A sample of 110 primarily Black pregnant women reporting smoking in the past week were recruited from prenatal care clinics and randomly assigned to CD-5As (n = 26), CM-Lite (n = 28), CD-5As plus CM-Lite (n = 30), or treatment as usual (n = 26). Self-report of smoking, urine cotinine, and breath CO were measured 10 weeks following randomization.Results: Participants rated both interventions highly (e.g., 87.5% of CD-5As participants reported increases in likelihood of quitting), but most CM-Lite participants did not initiate reinforcement sessions and did not show increased abstinence. CD-5As led to increased abstinence as measured by cotinine (43.5% cotinine negative vs. 17.4%; odds ratio [OR] = 10.1, p = .02) but not for CO-confirmed 7-day point prevalence (30.4% abstinent vs. 8.7%; OR = 5.7, p = .06). Collapsing across CM-Lite status, participants receiving the CD-5As intervention were more likely to talk to a doctor or nurse about their smoking (60.5% vs. 30.8%; OR = 3.0, p = .02).Conclusions: Low-intensity participant-initiated C...

Examination of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) Factor Structure in a Sample of Pregnant Smokers

“…This level of dependence is lower than that of smokers in many of the studies that have evaluated the WISDM in older samples, 11,15,59 but is similar to that of a young adult sample of smokers 60 and samples of pregnant smokers participating in smoking cessation intervention trials. 21,23,61 Few studies have evaluated the WISDM in young, less dependent samples of smokers. One study has evaluated the WISDM in two samples of college smokers.…”

Nursing interventions to promote smoking cessation during pregnancy: An integrative review

“…The duration of each intervention varied significantly (see Table 1 ) allowed subjects to participate in the study up to and including the second trimester [3,[18][19][20][25][26][27][28][29] . Eleven of the twenty-four studies either did not specify the time during the pregnancy for the initiation of the intervention or allowed subjects to join the study up until the last 12 weeks of gestation.…”

“…There was a range in the studies based on the length of the intervention (see Table 1 [3,6,18,19,24,25,27,28,32,33,35,37] . Approximately half of the 24 studies followed the women after childbirth.…”

“…Bullock et al (2009) distributed literature to women that highlighted the importance of smoking cessation. The women received a total of 8 booklets in this study [25] . Campbell et al (2009) mailed out information about smoking cessation to women in their study [31] .…”

“…[6,19,20,31] . Computer programs were issued by Campbell et al (2006), Lawrence et al (2003) and Ondersma et al (2011) [17,29,31] . Hajek et al…”