Quit for keeps: tailored smoking cessation guides for pregnancy and beyond

Abstract

Although health care providers appear to be an obvious choice for delivering smoking cessation education, they often lack the resources, training, and time to provide anything more than a recommendation to quit and generic pamphlets for reinforcement. Traditionally, this type of material is designed to include information for many potential users, thus making it diYcult for an individual to find the pieces most relevant to them. In contrast, tailored print materials provide only information which is relevant to a subject, making it far more usable. One study assessing tailored print messages found a threefold increase in cessation rates among patients in a family practice setting, four months after receipt of tailored versus untailored smoking cessation messages.1 Numerous other studies, targeting a number of diVerent populations, have also shown that tailored messages are an eVective intervention for smoking cessation. In tailoring, we use individual patient responses to select only relevant behaviour change messages. These messages provide information specific to an individual's needs and interests and can reinforce messages from health professionals. Because they are personalised, tailored materials oVer a potentially superior alternative to generic materials designed to reach a broad audience. Quit for Keeps used a pre-test/post-test experimental design to test the eVects of tailored interventions on pregnant smokers. MethodsParticipants in this study included 92 women enrolled at the Taubman obstetrics and gynaecology (ob/gyn) clinic at the University of Michigan and 81 women enrolled at the ob/gyn clinic at the University of North Carolina hospital from December 1996 to December 1997. Eligible participants were those who reported having smoked at least 100 cigarettes in their lifetime and who were either still smoking or had quit since becoming pregnant. Subjects were screened for eligibility during the New to the Nurse orientation program in North Carolina or during their first pre-natal visit to the clinic in Michigan. Potential subjects were given a hand held computer (Apple Newton MessagePad) and asked to fill out a short screening survey. After the computer determined that a subject was eligible, she was then approached by a research assistant and asked to participate in the project. Consenting women were then given the hand held computer for a second time and asked to complete the baseline questionnaire which assessed smoking status and asked questions on behavioural and psychosocial variables, including: stages of change for quitting smoking, perceived benefits of and barriers to quitting, self eYcacy, and demographic information. These constructs were used to create the tailored messages for those subjects randomised to the experimental condition. A urine sample was collected at baseline to confirm smoking status, and values < 80 ng/ml were considered indicative of abstinence.Subjects were then randomised via computer algorithm and assigned to either the control or experimental condition. Subjects ...

Handheld Computer-assisted Self-interviews: User Comfort Level and Preferences

“…38 The participating clinics serve women from a range of socioeconomic backgrounds including many with Medicaid. Site 1 included an obstetric and gynecology (OB-GYN) clinic in Michigan, and Site 2 included 2 adjoining OB-GYN clinics in North Carolina.…”

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

“…Recruiting participants for clinical trials can be challenging in general (e.g., Harris et al, 2003;Ross et al, 1999), and this has been particularly the case for smoking cessation trials of pregnant women, which often have difficulty meeting accrual goals (e.g., Cinciripini et al, 2000;Emmons et al, 2000;Goldenberg et al, 2000; Pollak et al, 2006;Ruggiero et al, 2003;Solomon et al, 2000;Strecher et al, 2000). Trials focusing on relapse prevention with this population have the additional challenge of recruiting from a yet smaller proportion of the population: pregnant women who smoked prior to their pregnancy but are currently abstaining from smoking.…”

“…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 this has been particularly the case for smoking cessation trials of pregnant women, which often have difficulty meeting accrual goals (e.g., Cinciripini et al, 2000;Emmons et al, 2000;Goldenberg et al, 2000; Pollak et al, 2006;Ruggiero et al, 2003;Solomon et al, 2000;Strecher et al, 2000). Trials focusing on relapse prevention with this population have the additional challenge of recruiting from a yet smaller proportion of the population: pregnant women who smoked prior to their pregnancy but are currently abstaining from smoking.…”

Self‐help smoking cessation interventions in pregnancy: a systematic review and meta‐analysis

“…Sensitivity analyses were carried out excluding trials that recruited pregnant quitters at baseline, and did not separate them from smokers for analysis [21,24], that provided more than 15 minutes of contact time [20], and included either clinical reinforcement or where it was difficult to determine whether face‐to‐face contact included any smoking cessation counselling [25–27]. These ‘borderline trials’ were removed from analyses in order to establish whether they introduced bias [28].…”

“…The remaining three trials of the 15 identified compared a self‐help booklet to tailored self‐help guides [24], basic self‐help materials to the same materials plus six self‐help videos [29] and a self‐help booklet to the same booklet plus a tailored interactive telephone system [37]. Two of these trials provided the more intensive experimental arm materials by post [24,29]; the other provided an information brochure about the telephone system by post and a 10‐minute phone call instructing participants on its use [37].…”