Health education for pregnant smokers: its behavioral impact and cost benefit.

Abstract

OBJECTIVES. A randomized trial (the Birmingham Trial II) was conducted to evaluate the behavioral impact of health education methods among 814 female smokers at four public health maternity clinics. METHODS. Four hundred patients were randomly assigned to an Experimental (E) Group, and 414 were assigned to a Control (C) Group. Self-reports and saliva cotinine tests confirmed smoking status at the first visit, at midpregnancy, and at end of pregnancy. RESULTS. The E Group exhibited a 14.3% quit rate and the C Group an 8.5% quit rate. A Historical Comparison (C) Group exhibited a 3.0% quit rate. Black E and C Group patients had higher quit rates than White E and C Group patients. A cost-benefit analysis found cost-to-benefit ratios of $1:$6.72 (low estimate) and $1:$17.18 (high estimate) and an estimated savings of $247,296 (low estimate) and $699,240 (high estimate). CONCLUSION. Health education methods are efficacious and cost beneficial for pregnant smokers in public health maternity clinics.

Differences in Quit Attempts and Cigarette Smoking Abstinence Between Whites and African Americans in the United States: Literature Review and Results From the International Tobacco Control US Survey

“…Clinical cohort participants differ from the general population in that they, even those in the usual care arm, receive regular contact with clinical staff 29 or primary care providers, 38 are at higher risk of morbidity, 29 or are currently receiving provider care. 30,31,33 Clinical cohort participants may have been derived from people recently filling a prescription for nicotine replacement therapy, 35 and in some instances, "modified" usual care was provided, so the nonintervention participants received smoking cessation manuals and resources, 33 newsletters and self-help materials, 34 or counseling sessions. 36 Inclusion criteria, such as a minimum number of cigarettes per day, limited age ranges, and the requirement for no current mental health diagnosis likely made the clinical cohort studies less representative of the population.…”

“…The definitions of "quit attempt" and "abstinence" varied greatly, and in some cases the definition of abstinence included cigarettes and other tobacco products. 34,42 The definition of "current smoker" varied considerably as well, with definitions ranging from those who took at least one puff of one cigarette within the past week 30 to those smoking at least five cigarettes per week, for most days of the week, for at least 3 months. 41,44 Racial and ethnic category definitions were not consistent: in some cases the racial categories of African American and white were inclusive of Hispanic ethnicity, while in other instances they were not.…”

“…Two of these were biochemically validated. 33,36 Six analyses, [29][30][31][32]34,35 four [29][30][31][32] of which were biochemically verified, reported no significant differences in smoking cessation between white and African American smokers. One analysis, 37 among smokers utilizing the Veterans Health Administration, found African American smokers were significantly more likely than white smokers to remain abstinent.…”

“…Ten publications [29][30][31][32][33][34][35][36][37][38] reported on ten relevant analyses. As shown in Supplementary Table 3, three 33,36,38 of the 10 analyses indicated white smokers were significantly more likely than African American smokers to be abstinent.…”

Minimal smoking cessation interventions in prenatal, family planning, and well-child public health clinics

“…Several studies have established the effectiveness of smoking cessation interventions in primary health care services in general [8][9][10] and in public health clinics. [11][12][13][14][15][16] Current recommendations are that minimal smoking cessation interventions be incorporated in routine primary health care and that these interventions include, as a minimum, provider advice to quit smoking and written material or other help for quitting. [17][18][19] Most health professionals are aware and approve of these recommendations and report applying them to many of their patients.…”