Effectiveness of a brief counseling and behavioral intervention for smoking cessation in pregnant women

Abstract

Background

Educational methods, type of intervention and intervenor, number of modalities used, duration, and number of reinforcing sessions are related to the success of an intervention for smoking cessation. The use of new intervention models for smoking cessation that can help pregnant smokers and the study of its impact in Public Maternities constitute a public health priority.

Methods

A pre-test–post-test control group design was conducted to evaluate the effectiveness of a brief counseling and behavioral intervention among pregnant smokers in a public maternity hospital. At first visit, 33 patients were assigned consecutively to an experimental (E) group where they received the brief intervention and 24 were assigned to a control (C) group where they received usual care. Smoking status was reported by self-report and confirmed by expired air carbon monoxide at first visit and at 2 months follow-up.

Results

Using an intention to treat analysis, tobacco abstinence was reported by 33.3% in the intervention group compared to 8.3% in the usual care group (P = 0.02) (OR = 5.5).

Conclusions

Counseling and behavioral brief interventions seem to be promising approaches that can help women stop smoking during pregnancy.

Introduction

Although the risks of cigarette smoking during pregnancy are well known, the most recent Portuguese National Health Survey shows that 56% of women between 15 and 35 years old who smoked at the start of the pregnancy continue to smoke during pregnancy [1].

Pregnancy might be regarded as an opportunity for health providers to have an impact on maternal and infant health through smoking cessation, but this opportunity is rarely explored. Smoking cessation during pregnancy significantly reduces the risk of fetal death, low birth weight, and other complications of pregnancy [2], [3].

A recent publication from USPHS has shown a multiplicity of effective treatments that can double or triple smoking cessation rates [4]. Some of these interventions, such as brief interventions, are more appropriate to be used in a primary care facility and are very cost-effective [5], [6]. At the same time, several intervention models have been tested. The application of relatively simple models, primarily brief interventions with self-help manuals, has been shown to give better result than routine advice in pre-natal clinics [7], [8], [9], [10]. Health education methods for pregnant smokers have shown to provide smoking cessation rates between 10% and 14% in public health settings and 22–25% in private prenatal care [4], [5], [6], [7], [8], [9], [10], [11]. Nevertheless, the majority of these findings vary and are inconsistent [6], [9], [12]. Variables such as educational level, age, and parity are associated with the ability to stop smoking during pregnancy [11], [13], [14]. In a meta-analysis of 39 controlled smoking cessation trials, Kottke et al. [12] relate the type of intervention (face to face advice being better than others), the type of intervenor (both physician and non-physician counselors better than either alone), the number of modalities used in the intervention, the number of reinforcing sessions, and the duration of the sessions with the success of an intervention [12]. The USPHS Clinical Practice Guideline for Treating Tobacco Use and Dependence [4] also indicates that there is a dose–response relationship for clinician-provided interventions. Person-to-person contact, session length, total amount of contact time, various types of clinicians, and counseling more often produce better outcomes.

Based on these research findings, we designed a counseling and behavioral intervention for pregnant smokers. The purpose of this study was to determine the extent to which a new type of intervention could be provided in a public maternity hospital by different care staff members (tested under typical practice conditions) and to evaluate the effectiveness of the intervention methods.