The effectiveness of a nurse‐managed perinatal smoking cessation program implemented in a rural county

Abstract

The present study (a) examined the effectiveness of a nurse-managed smoking cessation program, that was totally integrated into routine perinatal care, on the cessation rates of pregnant smokers in a rural community, and (b) assessed the subject characteristics associated with smoking cessation success. Data were collected from a convenience sample of 194 pregnant women who stated that they were smokers at the onset of their pregnancies. The study compared the effects of usual care (n = 93) versus the Smoke Free Baby & Me program (n = 101), which included the American Cancer Society's Make Yours a Fresh Start Family program. Smoking status was measured by self-report and urinary cotinine at four points during pregnancy and postpartum. At the postpartum visit, more women in the experimental group reported that they were not smoking compared with those in the control group (37.3% vs. 16.7%), Pearson's chi2 (n = 87) = 4.37, p = .037, and they had higher validated (urinary cotinine <200 ng/ml) smoking cessation rates (n = 80, t = 2.449, p = .017) if they had quit smoking by the first prenatal visit. Smoking cessation was positively associated with level of education and negatively associated with gravidity, parity, the number of smokers in the household, and the number of cigarettes smoked per day at the first prenatal visit. Significant discordance was found between self-report and urinary cotinine assays at all prevalence points, regardless of group. In conclusion, this nurse-delivered program integrated into perinatal care influenced the smoking behaviors of "recent quitters" but had no effect on those who reported smoking at the first prenatal visit. Implications for clinical practice are discussed.

Effect of digital health, biomarker feedback and nurse or midwife-led counselling interventions to assist pregnant smokers quit: a systematic review and meta-analysis

“… 78 121–123 However, unlike the pooled estimates, some TTM-based studies have also reported increases in CA at various postpartum periods. 121–126 As for 5A-based NoMC interventions, two out of five studies reported increases in PPA at postpartum 79 119 and one at follow-up, 120 respectively, in line with the pooled estimate. However, both Loukopoulou et al and Althabe et al did not find a significant association between this type of intervention and PPA in late pregnancy 117 and postpartum, 136 respectively.…”

“…Four studies evaluated the effect of the TTM-based counselling by nurses, midwives and/or other professionals 78 121–123. Three studies assessed cognitive behavioural therapy (CBT) based counselling 124–126.…”

A systematic review of the quality of reporting in published smoking cessation trials for pregnant women: an explanation for the evidence-practice gap?

“…Twenty individually randomised controlled trials [35],[37],[38],[41],[43],[45],[46],[48]–[51],[56]–[64], six cluster randomised controlled trials [40],[42],[52]–[55], and four non-randomised controlled trials (which used quasi-randomisation methods) [36],[39],[44],[47] were identified. The majority of studies (n = 20) were conducted in the United States [35]–[38],[41],[43],[45]–[47],[50],[51],[54],[56]–[59],[61]–[64], with five studies conducted in the United Kingdom [39],[42],[49],[53],[60], two in the Netherlands [40],[44], and one study each conducted in Poland [55], Canada [48], and New Zealand [52].…”

Impact of an incentive‐based prenatal smoking cessation program for low‐income women in Colorado

“…Implementation of an intervention based on an expanded version of the 5A's model (Ask, Advise, Assess, Assist, Arrange) delivered by trained health educators to low income women in rural South-Central Appalachia was associated with increased birthweights and 50% fewer NICU admissions compared to a historical control group (Bailey, 2015). In contrast, a study by Britton et al reported no impact on birth outcomes associated with implementation of a nurse-managed cessation program based upon the 5A's that was completely integrated into prenatal care (Avidano Britton, Brinthaupt, Stehle, & James, 2006;Britton, James, Collier, Sprague, & Brinthaupt, 2013). The BMTF program has also been implemented in Tennessee in which a 61% reduction in LBW among 866 BMTF participants with high levels of participation compared to a birth certificate reference population of women of all income levels was observed (Zhang et al, 2017).…”