Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women
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This study evaluated a theory-guided cognitive-behavioral counseling (CBC) intervention for smoking cessation during pregnancy and postpartum. It also explored the mediating role of cognitive-affective variables on the impact of CBC. Underserved inner city pregnant women (N = 277) were randomized to the CBC or a best practice (BP) condition, each of which consisted of two prenatal and two postpartum sessions. Assessments were obtained at baseline, late pregnancy, and 1- and 5-months postpartum. An intent-to-treat analysis found no differences between the two groups in 7-day point-prevalence abstinence. However, a respondents-only analysis revealed a significantly higher cessation rate in the CBC (37.3 %) versus the BP (19.0 %) condition at 5-months postpartum follow-up. This effect was mediated by higher quitting self-efficacy and lower cons of quitting. CBC, based on the Cognitive-Social Health Information Processing model, has the potential to increase postpartum smoking abstinence by assessing and addressing cognitive-affective barriers among women who adhere to the intervention.
KeywordsSmoking cessation Underserved pregnant women Postpartum Cognitive behavioral intervention Psychosocial mediators
This study was supported by American Cancer Society Grant TURSG 02-227-01, the National Institute of Health Grants RC1 CA145063 and R01 CA104979, and the Fox Chase Cancer Center Behavioral Research Core Facility P30 CA06927. The authors would like to thank Mary Anne Ryan and Deirdre Kurtz for their technical assistance.
Compliance with ethical standards
Conflict of interest
Minsun Lee, Suzanne M. Miller, Kuang-Yi Wen, Sui-kuen Azor Hui, Pagona Roussi and Enrique Hernandez declare that they have no conflict of interest.
Human and animal rights and Informed consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
- Baldwin, A. S., Rothman, A. J., Hertel, A. W., Linde, J. A., Jeffery, R. W., Finch, E. A., et al. (2006). Specifying the determinants of the initiation and maintenance of behavior change: An examination of self-efficacy, satisfaction, and smoking cessation. Health Psychology, 25, 626–634. doi: 10.1037/0278-618.104.22.1686 CrossRefPubMedGoogle Scholar
- Chang, J., Alexander, S., Holland, C., Arnold, R., Landsittel, D., Tulsky, J., et al. (2013). Smoking is bad for babies: Obstetric care providers’ use of best practice smoking cessation counseling techniques. American Journal of Health Promotion, 27, 170–176.PubMedCentralCrossRefPubMedGoogle Scholar
- Collins, B. N., Wileyto, E. P., Hovell, M. F., Nair, U. S., Jaffe, K., Tolley, N. M., et al. (2011). Proactive recruitment predicts participant retention to end of treatment in a secondhand smoke reduction trial with low-income maternal smokers. Translational Behavioral Medicine, 1, 394–399. doi: 10.1007/s13142-011-0059-6 PubMedCentralCrossRefPubMedGoogle Scholar
- Cranford, J. A., Shrout, P. E., Iida, M., Rafaeli, E., Yip, T., & Bolger, N. (2006). A procedure for evaluating sensitivity to within-person change: Can mood measures in diary studies detect change reliably? Personality and Social Psychology Bulletin, 32, 917–929. doi: 10.1177/0146167206287721 PubMedCentralCrossRefPubMedGoogle Scholar
- Dornelas, E. A., Magnavita, J., Beazoglou, T., Fischer, E. H., Oncken, C., Lando, H., et al. (2006). Efficacy and cost-effectiveness of a clinic-based counseling intervention tested in an ethnically diverse sample of pregnant smokers. Patient Education and Counseling, 64, 342–349. doi: 10.1016/j.pec.2006.03.015 CrossRefPubMedGoogle Scholar
- Egerter, S., Bravemen, P., & Marchi, K. (2002). Timing of insurance coverage and use of prenatal care among low-income women. Research and Practice, 92, 423–427.Google Scholar
- El-Khorazaty, M. N., Johnson, A. A., Kiely, M., El-Mohandes, A. A. E., Subramanian, S., Laryea, H. A., et al. (2007). Recruitment and retention of low-income minority women in a behavioral intervention to reduce smoking, depression, and intimate partner violence during pregnancy. BMC Public Health, 7, 233. doi: 10.1186/1471-2458-7-233 PubMedCentralCrossRefPubMedGoogle Scholar
- El-Mohandes, A. A., Kiely, M., Joseph, J. G., Subramanian, S., Johnson, A. A., Blake, S. M., et al. (2008). An intervention to improve postpartum outcomes in African-American mothers: A randomized controlled trial. Obstetrics and Gynecology, 112, 611–620. doi: 10.1097/AOG.0b013e3181834b10 PubMedCentralCrossRefPubMedGoogle Scholar
- Fiore, M., Bailey, W., Cohen, S., Dorfman, S., Goldstein, M., Gritz, E., et al. (2000). Treating tobacco use and dependance. Clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.Google Scholar
- Fiore, M., Jaen, C., Baker, T., Bailey, W., Benowitz, N., Curry, S., et al. (2008). Treating tobacco use and dependence: 2008 update. Clinical practice guidelines. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.Google Scholar
- Joseph, J. G., El-Mohandes, A. A., Kiely, M., El-Khorazaty, M. N., Gantz, M. G., Johnson, A. A., et al. (2009). Reducing psychosocial and behavioral pregnancy risk factors: Results of a randomized clinical trial among high-risk pregnant african american women. American Journal of Public Health, 99, 1053–1061. doi: 10.2105/AJPH.2007.131425 PubMedCentralCrossRefPubMedGoogle Scholar
- Katz, K. S., Blake, S. M., Milligan, R. A., Aharps, P. W., White, D. B., Rodan, M. F., et al. (2008). The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women. BMC Pregnancy Childbirth, 8, 22. doi: 10.1186/1471-2393-8-22 PubMedCentralCrossRefPubMedGoogle Scholar
- Mullen, P. D., DiClemente, C., & Bartholomew, L. (2000). Theory and context and project PANDA: A program to help postpartum women stay off cigarettes. In L. K. Bartholomew, G. S. Parcel, G. Kok, & H. Gottlieb (Eds.), Designing theory and evidence-based health promotion programs (pp. 453–477). Mountain View, CA: Mayfield Publishers.Google Scholar
- Paskett, E. D., Reeves, K. W., McLaughlin, J. M., Katz, M. L., McAlearney, A. S., Ruffin, M. T., et al. (2008). Recruitment of minority and underserved populations in the United States: The Centers for Population Health and Health Disparities experience. Contemporary Clinical Trials, 29, 847–861. doi: 10.1016/j.cct.2008.07.006 PubMedCentralCrossRefPubMedGoogle Scholar
- Roske, K., Schumann, A., Hannover, W., Grempler, J., Thyrian, J. R., Rumpf, H. J., et al. (2008). Postpartum smoking cessation and relapse prevention intervention: A structural equation modeling application to behavioral and non-behavioral outcomes of a randomized controlled trial. Journal of Health Psychology, 13, 556–568. doi: 10.1177/1359105308088528 CrossRefPubMedGoogle Scholar
- Schnoll, R. A., Rothman, R. L., Wielt, D. B., Lerman, C., Pedri, H., Wang, H., et al. (2005). A randomized pilot study of cognitive-behavioral therapy versus basic health education for smoking cessation among cancer patients. Annals of Behavioral Medicine, 30, 1–11. doi: 10.1207/s15324796abm3001_1 CrossRefPubMedGoogle Scholar
- Smith, J. C., & Schatz, B. R. (2010). Feasibility of mobile phone-based management of chronic illness. In AMIA annual symposium proceedings (pp. 757–761).Google Scholar
- Tong, V. T., Jones, J. R., Dietz, P. M., D’Angelo, D., & Bombard, J. M. (2009). Trends in smoking before, during, and after pregnancy—Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 sites, 2000–2005. MMWR Surveillance Summaries, 58, 1–29.Google Scholar
- Tran, T., Reeder, A., Funke, L., & Richmond, N. (2013). Association between smoking cessation interventions during prenatal care and postpartum relapse: Results from 2004 to 2008 multi-state PRAMS data. Maternal and Child Health Journal, 17, 1269–1276. doi: 10.1007/s10995-012-1122-8 CrossRefPubMedGoogle Scholar
- Wen, K. Y., Miller, S. M., Kilby, L., Fleisher, L., Belton, T. D., Roy, G., et al. (2014a). Preventing postpartum smoking relapse among inner city women: Development of a theory-based and evidence-guided text messaging intervention. JMIR Research Protocols, 3, e20. doi: 10.2196/resprot.3059 PubMedCentralCrossRefPubMedGoogle Scholar
- Wen, K. Y., Miller, S. M., Lazev, A., Fang, Z., & Hernandez, E. (2012). Predictors of smoking cessation counseling adherence in a socioeconomically disadvantaged sample of pregnant women. Journal of Health Care for the Poor and Underserved, 23, 1222–1238. doi: 10.1353/hpu.2012.0096 CrossRefPubMedGoogle Scholar
- Wen, K. Y., Miller, S. M., Roussi, P., Belton, T. D., Baman, J., Kilby, L., et al. (2014b). A content analysis of self-reported barriers and facilitators to preventing postpartum smoking relapse among a sample of current and former smokers in an underserved population. Health Education Research,. doi: 10.1093/her/cyu048 PubMedGoogle Scholar
- Windsor, R., Clark, J., Cleary, S., Davis, A., Thorn, S., Abroms, L., et al. (2014). Effectiveness of Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Dissemination Project: A science to prenatal care practice partnership. Maternal and Child Health Journal, 18, 180–190. doi: 10.1007/s10995-013-1252-7 CrossRefPubMedGoogle Scholar