Adapting Smoking Relapse–Prevention Materials for Pregnant and Postpartum Women: Formative Research

Quinn, Gwendolyn P.; Ellison, Bethany Bell; Meade, Cathy D.; Roach, C. Nannette; Lopez, Elena; Albrecht, Terrance L.; Brandon, Thomas H.

doi:10.1007/s10995-005-0046-y

Cited by 32 publications

(29 citation statements)

References 16 publications

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Section: Overview Of Clinical Trialmentioning

confidence: 99%

“…Although pregnant ex-smokers face many of the same risk factors that predict relapse in the general population (e.g., depression, weight concerns, low social support), these factors may be particularly potent among pregnant and postpartum women (Quinn et al, 2006). Importantly, the motivation to remain abstinent differs among general population quitters and pregnant ex-smokers (Stotts et al, 1996(Stotts et al, , 2000.…”

Section: Overview Of Clinical Trialmentioning

confidence: 99%

“…Clinical experience indicates that smokers in general tend to quit with the goal of continued abstinence, yet many pregnant women who quit smoking are motivated primarily by concerns about the health of the fetus, and therefore plan to abstain only during their pregnancy (Curry et al, 2001;Roske et al, 2006). Women also face unique stressors after they give birth, such as: identity confusion during the transition between pregnancy and postpartum, the reintroduction of smoking cues (e.g., spousal smoking) that were avoided during pregnancy, and the increased stress of caring for a new baby (Quinn et al, 2006). These topics and others were incorporated into a new set of 10 Forever Free for Baby and Me™ booklets.…”

mentioning

confidence: 99%

“…These topics and others were incorporated into a new set of 10 Forever Free for Baby and Me™ booklets. For more information on the development and content of these booklets, see Quinn et al (2006).In the ongoing clinical trial we are comparing the efficacy of the Forever Free for Baby and Me booklets to usual care, comprising existing materials available from the National Cancer Institute and the American Cancer Society. We are attempting to recruit 714 pregnant women who have already quit smoking because of their pregnancy.…”

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confidence: 99%

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Clinical trials and tribulations: Lessons learned from recruiting pregnant ex-smokers for relapse prevention

Lopez

Simmons

Quinn

et al. 2008

CNTR

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The development of smoking cessation and relapse-prevention interventions for pregnant and postpartum women is a public health priority. However, researchers have consistently reported substantial difficulty in accruing this population into clinical trials. The problem is particularly acute for relapse-prevention studies, which must recruit women who have already quit smoking because of their pregnancy. Although an important target for tobacco control efforts, these individuals represent an extremely small subgroup of the general population. This paper describes multiple recruitment strategies utilized for a clinical trial of a self-help relapse-prevention program for pregnant women. The effectiveness of the strategies and the direct expense per participant accrued are provided. A proactive recruitment strategy (telephoning women whose phone numbers were purchased from a marketing firm) was ultimately much more successful than a variety of reactive strategies (advertisement, press releases, direct mail, web placement, healthcare provider outreach). There were few differences between proactively and reactively recruited participants on baseline variables; the primary difference was that the former had smoked fewer cigarettes per day and reported lower nicotine dependence prior to quitting. Strengths and limitations of the recruitment strategies are discussed.The risks associated with smoking during pregnancy are well established and highly publicized (Britton, 1998; CDC, 1995; United States Department of Health and Human Services [USDHHS], 1990[USDHHS], , 2001. Consequently, an increasing proportion of women (estimates range from 15% to 60%) spontaneously quit smoking immediately prior to or during their pregnancy (Ershoff et al., 2000;Morasco et al., 2006). However, maintenance of tobacco abstinence among pregnant and postpartum women remains a challenge. Smoking relapse rates among pregnant and postpartum women range from 70-80%, with approximately half of these women resuming smoking within the first twelve weeks postdelivery (Fingerhut et al., 1990;Ockene, 1993;Polanska et al., 2005; USDHHS, 2001). Postpartum smoking exposes the infant to environmental tobacco smoke, which is associated with a range of health problems in children including middle ear infection, asthma, sudden infant death syndrome, behavioral problems, and developmental delays (Charlton, 1994; USDHHS, 2006). Of course, by resuming smoking, the mother also reexposes herself to the myriad health risks associated with tobacco use. Given the high rate of self-quitting among pregnant smokers, as well as the success of interventions designed to motivate pregnant women to quit smoking (Melvin et al., 2000), pregnancy and the early postpartum period appear to offer unique opportunities to provide smoking relapseprevention interventions, although such efforts have met with at best modest success to date (Mullen, 2004).Recruiting participants for clinical trials can be challenging in general (e.g., Harris et al., 2003;Ross et al., 1999), and t...

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Section: Overview Of Clinical Trialmentioning

confidence: 99%

Section: Overview Of Clinical Trialmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical trials and tribulations: Lessons learned from recruiting pregnant ex-smokers for relapse prevention

Lopez

Simmons

Quinn

et al. 2008

CNTR

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“…Given the lack of efficacious interventions for this population, our research team developed a series of self-help booklets designed to prevent post-partum smoking relapse (21–23). The booklet series, entitled Forever Free for Baby & Me (FFBM) , was created based on prior research and formative evaluation and was recently tested in a randomized clinical trial.…”

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confidence: 99%

A Content Analysis of Attributions for Resuming Smoking or Maintaining Abstinence in the Post-partum Period

Correa

Simmons

Sutton

et al. 2014

Matern Child Health J

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Objectives A significant proportion of women who self-quit smoking during pregnancy subsequently relapse to smoking post-partum. This study examined free-text responses describing attributions of smoking relapse or maintained abstinence at 1, 8, and 12 months post-partum. Method This study reports secondary analyses from a randomized clinical trial (N = 504) for preventing post-partum smoking relapse. At each follow-up, one survey item asked the participant to describe why she resumed smoking or what helped her maintain abstinence. A thematic content analysis was conducted on responses from the 472 participants (94.0 % of the original sample) who returned at least 1 survey. Results Content analyses revealed several themes for participants’ reasons for relapse and abstinence. Stress was the most frequently cited reason for smoking relapse across all follow-ups. Health concerns for children and family was the most common reason provided for remaining abstinent. Chi-square analyses revealed differences in written responses related to income, age, and depressive symptoms. Conclusions Overall, these findings suggest that during the post-partum period, stress and familial health concerns are perceived contributors to smoking relapse and abstinence, respectively. These results confirmed key risk and protective factors that have been identified through other assessment modalities (e.g., quantitative surveys and focus groups). They also provide support for targeting these variables in the development, content, and delivery of future post-partum smoking relapse-prevention interventions. The high response rate to these open-ended attribution questions suggests that future studies would benefit from including these and similar items, to allow for additional insight into participant perspectives.

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Psychosocial interventions for supporting women to stop smoking in pregnancy

Chamberlain

O’Mara-Eves

Oliver

et al. 2013

Cochrane Database of Systematic Reviews

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Background Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and increasing in low- to middle-income countries. Objectives To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. Search methods In this fifth update, we searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data. Selection criteria Randomised controlled trials, cluster-randomised trials, randomised cross-over trials, and quasi-randomised controlled trials (with allocation by maternal birth date or hospital record number) of psychosocial smoking cessation interventions during pregnancy. Data collection and analysis Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, and subgroup analyses and sensitivity analysis were conducted in SPSS. Main results Eighty-six trials were included in this updated review, with 77 trials (involving over 29,000 women) providing data on smoking abstinence in late pregnancy. In separate comparisons, counselling interventions demonstrated a significant effect compared with usual care (27 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.75), and a borderline effect compared with less intensive interventions (16 studies; average RR 1.35, 95% CI 1.00 to 1.82). However, a significant effect was only seen in subsets where counselling was provided in conjunction with other strategies. It was unclear whether any type of counselling strategy is more effective than others (one study; RR 1.15, 95% CI 0.86 to 1.53). In studies comparing counselling and usual care (the largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy (eight studies; average RR 1.06, 95% CI 0.93 to 1.21). However, a clear effect was seen in smoking abstinence at zero to five months postpartum (10 studies; average RR 1.76, 95% CI 1.05 to 2.95), a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77), and a significant effect at 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), but not in the longer term. In other comparisons, the effect was not significantly different from the null effect for most secondary outcomes, but sample sizes were small. Incentive-based interventions had the largest effect size compared with a less intensive intervention (one study; RR 3.64, 95% CI 1.84 to 7.23) and an alternative intervention (one study; RR 4.05, 95% CI 1.48 to 11.11). Feedback interventions demonstrated a significa...

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Adapting Smoking Relapse–Prevention Materials for Pregnant and Postpartum Women: Formative Research

Cited by 32 publications

References 16 publications

Clinical trials and tribulations: Lessons learned from recruiting pregnant ex-smokers for relapse prevention

Clinical trials and tribulations: Lessons learned from recruiting pregnant ex-smokers for relapse prevention

A Content Analysis of Attributions for Resuming Smoking or Maintaining Abstinence in the Post-partum Period

Psychosocial interventions for supporting women to stop smoking in pregnancy

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