Effectiveness of a Combined Prenatal and Postpartum Smoking Cessation Program

Abstract

Women frequently quit smoking during pregnancy but then relapse postpartum. The BABY & ME-Tobacco Free program combines prenatal and postpartum smoking cessation counseling and biomarker feedback with monthly postpartum incentives. The settings included 22 sites (WIC offices and prenatal clinics) in upstate New York. A quasi-experimental design was used to evaluate this intervention, that included four face-to-face prenatal sessions with a counselor who did smoking cessation counseling, carbon monoxide testing and random saliva cotinine testing. For 1 year postpartum, mothers were biochemically tested every 3-4 weeks and, if negative, were issued a voucher for diapers. Three implementation models were studied: multi-tasking counselors at fixed sites (Models 1 and 2) versus itinerant smoking cessation specialists (Model 3). Outcomes included biochemically validated abstinence rates during pregnancy and postpartum. Logistic regression was used to identify predictors of postpartum abstinence and program dropout. Proportional hazards regression was used to compare implementation models. Of the 777 pregnant women who enrolled in the program, 588 were eligible for the postpartum program. The intention to treat pregnancy quit rate was 60%. Postpartum, Model 3 showed consistently better quit outcomes than the other models. Predictors of abstinence at 6 months postpartum are: older age (OR = 1.07, 95% C.I. 1.02-1.12), lower baseline carbon monoxide level (OR = 0.69, 95% C.I. 0.49-0.97), Model 3 (OR = 4.60, 95% C.I. 2.80-7.57) and attending more prenatal sessions (OR = 3.52; 95% C.I. 2.19-5.65). The BABY & ME-Tobacco Free program is an effective smoking cessation program for pregnant and parenting women.

Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomized controlled trial

“…HSI and non‐HSI) and their effect sizes were similar to FTCD; therefore, for economy, it might be better to use the HSI, composed of only two items, for assessing cigarette dependency in pregnant smokers. The finding that lower expired CO levels predicted cessation is consistent with the previous finding for saliva cotinine 28, another biochemical marker of abstinence, and for CO levels predicting abstinence at 6 months postpartum 51, as well as with findings for non‐pregnant smokers 34. The finding for number of cigarettes smoked per day is consistent with the results of lower number of cigarettes smoked per day before pregnancy predicting cessation 18.…”

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

“…104,105,[108][109][110][111]113,[138][139][140][141][142][143][144][145][146][147][148][149][150] One study was included in the process review only as it was a survey of acceptability and feasibility and did not provide incentives to women. 151 One study 152 provided reimbursement to organisations providing care and one study included a question in a survey about reimbursement.…”

“…For category B-D studies, women were invited to participate in a range of activities to obtain the incentives, some of which were reported as usual care plus additional components 110,111,138 or an enhanced programme of care 108,[145][146][147][148][149] or involved the implementation of a new protocol. 104,113,139,140,142,143,150 These programme components involved either one or a combination of advice, counselling, group sessions, written materials and motivational strategies and, in one study, a programme of supervised exercise. When extracting the IRBCT data, incentive and reward elements were identified reliably (kappa = 0.87).…”

“…Intervention arms were identified to use an average of 6.62 [standard deviation (SD) 3.1] BCTs, ranging from one 109 to 12, 145 emphasising that incentive interventions are complex and consist of various potentially active ingredients. Control/usual care arms used an average of 1.11 (SD 0.9) BCTs, ranging from zero 109,143 to three. 138 Out of 41 BCTs rated, study arms were identified to have used 30 ( Figure 7), with the BCTs used most often being 'providing information on the consequences of smoking cessation' (n = 24), 'measuring CO' (n = 18), which mostly took the form of objectively validating smoking status within intervention encounters, and 'facilitating goal-setting' (n = 15), which in most studies took the form of setting a formal quit date.…”

“…In addition to the BCTs, six studies were also rated as being engaged in the WIC programme 105,[141][142][143]145,149 and one study was rated as being partially engaged in the WIC programme. 110 BCTs used in the WIC programme were recorded separately without inferring the presence of specific BCTs given the variation in WIC programme implementation.…”