Characteristics and Factors Associated with the Risk of a Nicotine Exposed Pregnancy: Expanding the CHOICES Preconception Counseling Model to Tobacco

Abstract

The preconception counseling model tested in the CDC funded Project CHOICES efficacy trial to reduce the risk of an alcohol-exposed pregnancy (AEP) could be extended to smokers to prevent a nicotine-exposed pregnancy (NEP), when pharmacotherapy can be provided safely and disclosure of these risk behaviors is more likely. The CHOICES model, which incorporates motivational interviewing, encourages reduction of AEP risk by decreasing risky drinking or using effective contraception; in the efficacy trial, most women chose both options. We conducted a secondary analysis of the CHOICES epidemiologic survey data (N = 2,672) (Project CHOICES Research Group in Am J Prev Med 23(3), 166-173, 2002) to identify the prevalence of risk of NEP and the factors associated with this risk using logistic regression modeling procedures. Conducted in six settings with women at risk for AEP, the percentage of AEP was 12.5% (333/2,672) among women of childbearing age (18-44). A total of 464 of the 2,672 (17.4%) were at risk for NEP. Among women at-risk of an unplanned pregnancy (n = 1,532), the co-occurrence of AEP and NEP risk was more prevalent (16.3%) than AEP risk alone (5.5%) or NEP risk alone (14.0%). In the multivariable model, statistically significant correlates for NEP risk included lifetime drug use, prior alcohol/drug treatment, drug use in the last 6 months, being married or living with a partner, having multiple sexual partners in the last 6 months, physical abuse in the last year, and lower levels of education. These findings suggest that preconception counseling for NEP could be combined with a program targeting AEP.

Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review

“…Targeted preconception interventions have been found to be effective for other substance use among women. 127 By targeting AI/AN women before conception, this approach could have downstream effects on preventing tobacco use among AI/AN children. 1,128…”

Substance Use and Preconception Care: A Review of the Literature

“…MI is an effective technique to elicit change. The objective of this intervention, which has roots in cognitive-behavioral approaches, is to provide individuals with sufficient education and knowledge regarding the severity of preconception risk behaviors on future birth outcomes, with the hope that, as a result, individuals will become introspective and self-motivated to change (51,52,(64)(65)(66). SAMHSA offers online training to develop or enhance motivational interviewing skills, integrating the six elements of the FRAMES model into brief interventions, optimizing the motivation to change.…”

“…Although the CHOICES intervention is used primarily to reduce AEP, Parrish et al proposed expanding the CHOICES intervention to reduce nicotine-exposed pregnancy (NEP) and to promote the smoking cessation intervention for women at risk (66). They found that the co-occurrence of AEP and NEP risks was more prevalent than the AEP risk alone (16%).…”

“…The risk of NEP was greater for women who were incarcerated and for those who were seen at substance abuse centers. A PCC intervention that targets multiple risk behaviors is more effective and efficient, especially for at-risk populations (43,66).…”

Prevention and Treatment of Smoking and Tobacco Use During Pregnancy in Selected Indigenous Communities in High-Income Countries of the United States, Canada, Australia, and New Zealand

“…100 Another program was effective for preconception smoking cessation counseling. 101 Approximately 45% of women in the general population stop smoking on finding out they are pregnant. 96 An equivalent figure is unknown for Indigenous women.…”