Effectiveness of a Pregnancy Smoking Cessation Program

doi:10.1111/j.1552-6909.1992.tb01755.x

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 21, Issue 5, September 1992, Pages 385-392

https://doi.org/10.1111/j.1552-6909.1992.tb01755.x Get rights and content

Objective

To evaluate two nursing approaches to promoting smoking cessation during initial antenatal visits.

Design

Experimental, with assignment to interventions using a random, alternate‐day strategy and blind assessment of smoking at baseline, 1 month postintervention, 36 weeks' gestation, and 6 weeks postpartum.

Setting/Participants:

224 daily smokers, fewer than 31 weeks' gestation, during first prenatal visit, at a teaching hospital antenatal clinic.

Interventions:

An evening class providing guidance on a self‐help program for 2 hours on a group basis or 20 minutes on an individual basis during the prenatal appointment.

Main outcome measure:

Smoking cessation, confirmed by urinary cotinine levels.

Results:

All women assigned to the referral intervention received a referral, but none attended the classes. In contrast, 93% assigned to the immediate intervention received the intervention. The group receiving immediate intervention had two to three times higher rates of cessation at all follow‐up periods, with significant differences at the 1‐month follow‐up. There were certain similarities between the groups.

Conclusion:

Cessation interventions should be administered during the first prenatal visit.

Section snippets

Design and sample

All new referrals to an antenatal clinic were screened for eligibility. The eligibility criteria were confirmed pregnancy, smoked at least one cigarette daily at the time of first visit to the clinic, and less than 31 weeks’ gestation. Self-reported cigarette smoking and urinary cotinine levels were monitored before intervention, 1 month postintervention, at 36 weeks’ gestation, and at 6 weeks postpartum.

The usual care control interventionvris provided to all subjects by a research nurse. This

Patient accrual and follow-up

The numbers of women screened and recruited over time are provided in Table 1. Of the 267 daily smokers identified, 39 were ineligible because of the following reasons: less than 31 weeks’ gestation (n = 21), missed abortions (n = 4), consultations for therapeutic abortion (n = 3), congenital anomaly (n = 1), participated in study during previous pregnancy (n = 3), severe retardation, psychiatric illness, or only 1-day consultation (n = 7).

Of the participating women, 76.3% provided complete data over all

Discussion

The immediate administration of a smoking cessation program at the first antenatal visit produced cessation rates comparable to the rates achieved in the experimental group (14%) in the study by Windsor et al. (1985). These results are encouraging, given that our control subjects had higher cessation rates than Windsor’s control subjects (5-6% versus 2%) and that our refusal rates were much lower (2% versus 19%) • Moreover, although Windsor’s study was terminated at delivery, the current study

Acknowledgments

This study was funded by the Ontario Ministry of Health and the Ontario Thoracic Society.

References (23)

G.E. Barnes et al.
Characteristics affecting successful outcome in the cessation of smoking
International Journal of Addictions
(1985)
K.E. Bauman et al.
The influence of observing carbon monoxide level on cigarette smoking by public prenatal patients
American Journal of Public Health
(1983)
B.R. Blishen et al.
A revised socioeconomic index for occupations in Canada
Canadian Review of Sociology and Anthropology
(1976)
B.G. Danaher et al.
A smoking cessation program for pregnant women: An exploratory study
American Journal of Public Health
(1978)
B.L. Davies et al.
Evaluation of the “Time to Quit” self help smoking cessation program
Canadian Journal of Public Health
(1992)
B.L. Davies et al.
Pregnant women’s decision making about smoking cessation.
(1987)
J.W. Donovan
Randomized controlled trial of anti‐smoking advice in pregnancy
British Journal of Preventive and Social Medicine
(1977)
D.H. Ershoff et al.
Behavioral, health and cost outcomes of an HMO‐based prenatal health education program
Public Health Reports
(1983)
Smoking behaviour of Canadians–1986
(1988)
J.R. Hebel et al.
Dose‐response of birth weight to various measures of maternal smoking during pregnancy
Journal of Clinical Epidemiology
(1989)

S.F. Johnson et al.

Changes in alcohol, cigarette and recreational drug use during pregnancy: Implications for intervention

American Journal of Epidemiology

(1987)

Cited by (47)

The risk of adverse pregnancy outcomes is increased in preeclamptic women who smoke compared with nonpreeclamptic women who do not smoke
2010, American Journal of Obstetrics and Gynecology
Citation Excerpt :
Our findings emphasize the need to promote smoking cessation during pregnancy and indicate a population that is at a higher risk of adverse pregnancy outcomes that should be subject to higher levels of counseling. Effective treatment is needed to improve smoking cessation rates,30-34 but this treatment is not always provided.34,35 Helping clinicians and policymakers to better understand factors that put women at risk for adverse pregnancy outcomes will help them to target their efforts toward those women at highest risk.
Maternal smoking and preeclampsia independently increase the risk of adverse pregnancy outcomes; however, smoking decreases the risk of preeclampsia. We sought to estimate the risk of adverse pregnancy outcomes among preeclamptic women who smoke and hypothesized that this risk would be increased, compared with nonpreeclamptic women who smoke or preeclamptic women who do not smoke.
With the use of the Niday Perinatal Database and multiple logistic regressions, we estimated the risk of adverse pregnancy outcomes in nonpreeclamptic women who smoke, preeclamptic women who do not smoke, and preeclamptic women who smoke in relation to nonpreeclamptic women who do not smoke.
The incidence of adverse pregnancy outcomes was more than twice as high among preeclamptic women who smoke as among nonpreeclamptic women who do not smoke. The following data were observed: small-for-gestational-age infant (odds ratio [OR], 3.40; 95% CI, 2.27–4.89), preterm birth (OR, 5.77; 95% CI, 4.50–7.35), very preterm birth (OR, 5.44; 95% CI, 3.51–8.11), abruption (OR, 6.16; 95% CI, 3.05–11.01), Apgar <4 at 5 minutes (OR, 3.11; 95% CI, 1.48–5.72), and stillbirth (OR, 3.39; 95% CI, 1.33–6.99).
Smoking decreases the risk of preeclampsia, but smokers with preeclampsia have an increased risk for adverse pregnancy outcomes.
A randomized controlled trial of the simple advice given by obstetricians in Guangzhou, China, to non-smoking pregnant women to help their husbands quit smoking
2005, Patient Education and Counseling
This is a randomized controlled trial to examine the effects of obstetrician's simple advice given to non-smoking pregnant women with the aim to help their husbands to give up smoking. Non-smoking pregnant women who were attending the Guangzhou Women and Children Health Care Centre and whose husbands were smokers were each randomised to an intervention (N = 380) or a control (N = 378) group. The members of the intervention group each received simple advice on encouraging their husbands to give up smoking and an educational booklet at their first antenatal visit, and reminders during subsequent visits, whereas the control group received none, as is the usual practice. Husbands’ not smoking for 7 and for 30 days were the main outcomes of the study; other outcomes included husbands’ attempts to stop and any decrease in the number of cigarettes smoked. These outcomes were assessed by means of a questionnaire responded to in the last month of pregnancy, which was subjected to ‘intention-to-treat’ analysis. Results show that more husbands in the intervention group had attempted to stop smoking (30.0% versus 22.2%; p = 0.02), reduced the number of cigarettes smoked (39.7% versus 17.7%; p < 0.0001), and had not smoked any cigarettes for the last 7 days before their wives completed the questionnaire (8.4% versus 4.8%; p = 0.04). The difference between groups in the number of husbands who had abstained from cigarettes for at least 30 days was not significant (6.1% versus 4.2%; p = 0.26). Obstetricians should consider incorporating advice on passive smoking into the antenatal programme for non-smoking pregnant women with smoking husbands.
A survey of pregnant smokers' interest in different types of smoking cessation support
2004, Patient Education and Counseling
The aim of this study was to survey pregnant smokers’ interest in different types of smoking cessation support. Interest in cessation support was assessed via telephone interviews with women identified as smokers at their first antenatal visit. Of 206 pregnant smokers interviewed, 87% (179/206) reported wanting to stop smoking, of whom 69% (124/179) expressed an interest in receiving help with stopping. Interest was highest for behavioural support (82%, 102/124) and self-help materials (77%, 95/124). There was a significant preference for individual versus group appointments, for ‘buddying’ among those not in professional/managerial occupations versus those in professional/managerial occupations, and for behavioural support among non-Caucasians versus Caucasians. These findings highlight the high level of interest expressed in support with stopping smoking among pregnant smokers. Smoking cessation services may benefit through offering a range of interventions for pregnant smokers, through considering ethnic and occupational status, and through routinely offering individual appointments.
Comparison of self-reported smoking and urinary cotinine levels in a rural pregnant population
2004, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
(a) to assess the accuracy of self‐reported smoking status in pregnant women from rural and small metropolitan statistical areas who stated they were smokers at the onset of pregnancy, (b) to compare the characteristics of these women who self‐reported a nonsmoker status at the first prenatal visit with those who reported a smoker status, and (c) to determine the characteristics that predict self‐reported smoking status and positive/negative urinary cotinine assays.
Seven private obstetric offices serving rural and small metropolitan statistical areas in upstate New York.
A convenience sample of 94 pregnant women who stated they were smokers at the onset of their pregnancies. Their mean age was 23 years and mean level of education was 11.9 years; 95% were White, 65% were single, and 65% were Medicaid‐funded.
Descriptive correlational design. At the first prenatal visit, the sensitivity and specificity of smoking and nonsmoking status were determined by comparing self‐reports of smoking status with urinary cotinine assays. Data were also analyzed for relationships among demographic variables and for predictors of smoking status and urinary cotinine.
The discordance rate between self‐reports of smoking status and urinary cotinine assays at the first prenatal visit for the total sample was 16.6%, significant at p < .001, chi‐square = 27.80, df= 1. Based on biochemical assays of > 200 ng/ml of cotinine indicating active smoking, 34.7% of women who denied smoking (specificity of 65.3%) and 10.4% of women who stated that they smoked (sensitivity of 89.5%) inaccurately reported their status (significant at p < .001). The number of cigarettes smoked per day was positively correlated with age, gravidity, parity, and number of smokers in the household. Gravidity and the number of smokers in the household were significant predictors of positive self‐report of smoking status and of positive urinary cotinine assay.
These results substantiate the unreliability of self‐report on smoking status in the pregnant population and in women who are recent quitters. Such findings have implications for clinical practice, such as (a) changes are necessary in how the prenatal interview assesses past and present tobacco use, (b) pregnant smokers who are multigravidae and who live with other smokers need more tailored interventions, and (c) more research is needed on how self‐report can be ethically and efficiently validated.
Smoking Cessation or Reduction in Pregnancy Treatment Methods: A Meta-Evaluation of the Impact of Dissemination
2003, American Journal of the Medical Sciences
Active and passive exposure to tobacco smoke during pregnancy and infancy is the most serious and preventable cause of adverse maternal, fetal, and infant outcomes in the United States. The multiple risks of tobacco exposure to mothers and infants are definitive, and the clinical and economic benefits of cessation have been documented. This article provides a synopsis of the state of the science and art in this specialized area and reviews the evidence for validity of patient assessment methods and the effectiveness of smoking cessation/reduction treatments for pregnant women. A synthesis of 4 topics is presented: (1) the validity of patient reports of smoking status and recent trends during pregnancy and postpartum; (2) definition of “Best Practice” smoking cessation methods for pregnant women; (3) the effect of dissemination of effective clinical practice methods among the 800,000+ pregnant US smokers each year; and (4) the evidence for the cost-benefit of improved maternal and infant outcomes from cessation.
Effect of digital health, biomarker feedback and nurse or midwife-led counselling interventions to assist pregnant smokers quit: A systematic review and meta-analysis
2023, BMJ Open

View all citing articles on Scopus

View full text

CLINICAL STUDIESEffectiveness of a Pregnancy Smoking Cessation Program

Objective

Design

Setting/Participants:

Interventions:

Main outcome measure:

Results:

Conclusion:

Section snippets

Design and sample

Patient accrual and follow-up

Discussion

Acknowledgments

Characteristics affecting successful outcome in the cessation of smoking

International Journal of Addictions

The influence of observing carbon monoxide level on cigarette smoking by public prenatal patients

American Journal of Public Health

A revised socioeconomic index for occupations in Canada

Canadian Review of Sociology and Anthropology

A smoking cessation program for pregnant women: An exploratory study

American Journal of Public Health

Evaluation of the “Time to Quit” self help smoking cessation program

Canadian Journal of Public Health

Pregnant women’s decision making about smoking cessation.

Randomized controlled trial of anti‐smoking advice in pregnancy

British Journal of Preventive and Social Medicine

Behavioral, health and cost outcomes of an HMO‐based prenatal health education program

Public Health Reports

Smoking behaviour of Canadians–1986

Dose‐response of birth weight to various measures of maternal smoking during pregnancy

Journal of Clinical Epidemiology

Changes in alcohol, cigarette and recreational drug use during pregnancy: Implications for intervention

American Journal of Epidemiology

CLINICAL STUDIES
Effectiveness of a Pregnancy Smoking Cessation Program