Kathryn I Pollak1, Laura J Fish2, Pauline Lyna3, Bercedis L Peterson4, Evan R Myers5, Xiaomei Gao3, Geeta K Swamy5, Angela Brown-Johnson6, Paul Whitecar6, Alicia K Bilheimer3, Pamela K Pletsch7. 1. Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC; kathryn.pollak@duke.edu. 2. Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC; 3. Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; 4. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC; 5. Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC; 6. Department of Obstetrics and Gynecology, Womack Army Medical Center, Ft Bragg, NC; 7. School of Nursing, University of Wisconsin, Madison, WI.
Abstract
INTRODUCTION: Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return). METHODS: We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum. RESULTS: Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences ( CONTROL: 36% [95% confidence interval [CI]: 29-43] vs. INTERVENTION: 35% [95% CI: 28-43], P = .81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%). CONCLUSIONS: Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking. IMPLICATIONS: Results suggest that high-risk and low-risk women might benefit from different types of smoking relapse interventions. Those who are lower risk of returning to smoking might benefit from stress reduction that is devoid of smoking content, whereas those who are higher risk might benefit from smoking relapse prevention.
RCT Entities:
INTRODUCTION: Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return). METHODS: We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum. RESULTS: Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences ( CONTROL: 36% [95% confidence interval [CI]: 29-43] vs. INTERVENTION: 35% [95% CI: 28-43], P = .81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%). CONCLUSIONS: Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking. IMPLICATIONS: Results suggest that high-risk and low-risk women might benefit from different types of smoking relapse interventions. Those who are lower risk of returning to smoking might benefit from stress reduction that is devoid of smoking content, whereas those who are higher risk might benefit from smoking relapse prevention.
Authors: Vani Nath Simmons; Steven K Sutton; Gwendolyn P Quinn; Cathy D Meade; Thomas H Brandon Journal: Nicotine Tob Res Date: 2013-11-07 Impact factor: 4.244
Authors: Thomas H Brandon; Vani Nath Simmons; Cathy D Meade; Gwendolyn P Quinn; Elena N Lopez Khoury; Steven K Sutton; Ji-Hyun Lee Journal: Am J Public Health Date: 2012-09-20 Impact factor: 9.308
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Authors: Jonathan Livingstone-Banks; Emma Norris; Jamie Hartmann-Boyce; Robert West; Martin Jarvis; Emma Chubb; Peter Hajek Journal: Cochrane Database Syst Rev Date: 2019-10-28
Authors: Jonathan Livingstone-Banks; Emma Norris; Jamie Hartmann-Boyce; Robert West; Martin Jarvis; Peter Hajek Journal: Cochrane Database Syst Rev Date: 2019-02-13
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