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Strengthen the Evidence for Maternal and Child Health Programs

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Abroms LC, Chiang S, Macherelli L, Leavitt L, Montgomery M. Assessing the National Cancer Institute's SmokefreeMOM Text-Messaging Program for Pregnant Smokers: Pilot Randomized Trial. Journal of Medical Internet Research 2017a;19:e333.

Link: https://www.ncbi.nlm.nih.gov/pubmed/28974483

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, Telephone Support, Parent Engagement, Patient Reminder/Invitation

Intervention Results:

Results indicate that the SmokefreeMOM program was highly rated overall and rated more favorably than the control condition in its helpfulness at 3-month follow-up (P<.01) and in its frequency of messaging at both 1-month and 3-month follow-ups (P<.001, P<.01, respectively). Despite the presence of technical problems, the vast majority of intervention participants read all program messages, and few participants unsubscribed from the program. There were no significant differences between groups on the use of extra treatment resources or on smoking-related outcomes. However, at the 3-month follow-up, some outcomes favored the intervention group.

Abroms LC, Johnson PR, Leavitt LE, Cleary SD, Bushar J, Brandon TH, et al. A randomized trial of text messaging for smoking cessation in pregnant women. American Journal of Preventive Medicine 2017b;53:781-90.

Link: https://www.ncbi.nlm.nih.gov/pubmed/28982527

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Parent Engagement, Telephone Support

Intervention Results:

Using an intention-to-treat analysis, 28.80% of the intervention group and 15.79% of the control group reported not smoking in the past 7 days at 1 month (p<0.01), and 35.20% of the intervention group and 22.67% of the control group reported not smoking in the past 7 days at 3 months (p<0.01). Biochemical verification of smoking status at 3 months indicated no significant differences between groups (15.60% in the intervention group and 10.93% in the control group [p=0.13]), although significant differences favoring the intervention were found for older smokers (p<0.05) and for those who enrolled in their second or third trimester of pregnancy (p<0.05). Self-report of late pregnancy 7- and 30-day point prevalence abstinence favored the intervention group (p<0.001, p<0.01). No significant differences were observed at the 6-month follow-up or in the postpartum period.

Abroms LC, Johnson PR, Heminger CL, Van Alstyne JM, Leavitt LE, Schindler-Ruwisch JM, Bushar JA. Quit4baby: results from a pilot test of a mobile smoking cessation program for pregnant women. Journal of Medical Internet Research Mhealth Uhealth. 2015 Jan 23;3(1):e10. doi: 10.2196/mhealth.3846.

Link: https://www.ncbi.nlm.nih.gov/pubmed/25650765

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Telephone Support, Parent Engagement, Incentives

Intervention Results:

Most participants responded to the program favorably. Highly rated aspects included the content of the program, skills taught within the program, and encouragement and social support provided by the program. Participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. Suggestions for improvement included increasing the message dose and making the quitpal more interactive.

Bailey SR, Heintzman JD, Marino M, Jacob RL, Puro JE, DeVoe JE, Burdick TE, Hazlehurst BL, Cohen DJ, Fortmann SP. Smoking-Cessation Assistance: Before and After Stage 1 Meaningful Use Implementation. American Journal of Preventive Medicine 2017 Aug;53(2):192-200. doi: 10.1016/j.amepre.2017.02.006. Epub 2017 Mar 29.

Link: https://www.ncbi.nlm.nih.gov/pubmed/28365090

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Incentives

Intervention Results:

Non-pregnant patients had decreased odds of current smoking over time; odds for all other outcomes increased except for medication orders from 2010 to 2012. Among pregnant patients, odds of assessment and counseling increased across all years. Odds of discussing or ordering of cessation medications increased from 2010 compared with the other 2 study years; however, medication orders alone did not change over time, and current smoking only decreased from 2010 to 2012. Compared with non-pregnant patients, a lower percentage of pregnant patients were provided counseling.

Bailey BA. Effectiveness of a pregnancy smoking intervention: The Tennessee Intervention for Pregnant Smokers program. Health Education and Behavior 2015;42:824-31.

Link: https://journals.sagepub.com/doi/full/10.1177/1090198115590780

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Person-to-Person Education, Peer Counselor, Motivational Interviewing, Telephone Support, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Consultation (Parent/Family)

Intervention Results:

Over 28% of intervention group women quit smoking, compared to 9.8% in the control group. Two thirds of intervention group women significantly reduced smoking by delivery, with 40%+ attempting to quit at least once. Compared to controls, intervention group women saw significantly better birth outcomes, including newborns weighing 270g more and 50% less likely to have a neonatal intensive care unit admission. Among intervention group participants, those who quit smoking had significantly better birth outcomes than those who did not quit smoking.

Bartholomew KS, Abouk R. The effect of local smokefree regulations on birth outcomes and prenatal smoking. Maternal and Child Health Journal 2016;20:1526-38.

Link: https://link.springer.com/article/10.1007%2Fs10995-016-1952-x

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Policy/Guideline (State)

Intervention Results:

Only more comprehensive smokefree regulations were associated with statistically significant favorable effects on birth outcomes in the full sample: Comprehensive (workplace/restaurant/bar ban) demonstrated increased birthweight (29 grams, p < 0.05) and gestational age (1.64 days, p < 0.01), as well as reductions in very low birthweight (−0.4 %, p < 0.05) and preterm birth (−1.5 %, p < 0.01); Restrictive (workplace/restaurant ban) demonstrated a small decrease in very low birthweight (−0.2 %, p < 0.05). Among less restrictive regulations: Moderate (workplace ban) was associated with a 23 g (p < 0.01) decrease in birthweight; Limited (partial ban) had no effect. Comprehensive’s improvements extended to most maternal groups, and were broadest among mothers 21+ years, non-smokers, and unmarried mothers. Prenatal smoking declined slightly (−1.7 %, p < 0.01) only among married women with Comprehensive.

Bell R, Glinianaia SV, van der Waal Z, Close A, Moloney E, Jones S et al. Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: Interrupted time series analysis with economic evaluation. Tobacco Control: An International Journal 2018;27:90-8.

Link: https://www.ncbi.nlm.nih.gov/pubmed/28202783

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Assessment (Provider)

Intervention Results:

After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter.

Berlin I, Grangé G, Jacob N, Tanguy ML. Nicotine patches in pregnant smokers: randomised, placebo controlled, multicentre trial of efficacy. British Medical Journal (Clinical Research Ed) 2014;348:g1622.

Link: https://www.bmj.com/content/348/bmj.g1622

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Nicotine Patches

Intervention Results:

Complete abstinence was achieved by 5.5% (n=11) of women in the nicotine patch group and 5.1% (n=10) in the placebo patch group (odds ratio 1.08, 95% confidence interval 0.45 to 2.60). The median time to the first cigarette smoked after target quit day was 15 days in both groups (interquartile range 13-18 in the nicotine patch group, 13-20 in the placebo patch group). The point prevalence abstinence ranged from 8% to 12.5% in the nicotine patch group and 8% to 9.5% in the placebo patch group without statistically significant differences. The nicotine substitution rate did not differ from 100%, and the self reported median compliance rate was 85% (interquartile range 56-99%) in the nicotine patch group and 83% (56-95%) in the placebo patch group, assessed at 1016 visits. The mean birth weight was 3065 g (SE 44 g) in the nicotine patch group and 3015 g (SE 44 g) in the placebo patch group (P=0.41). Diastolic blood pressure was significantly higher in the nicotine patch group than in the placebo patch group. The frequency of serious adverse events was similar between the groups, although more non-serious adverse reactions, mainly of skin, occurred in the nicotine patch group.

Brown QL, Hasin DS, Keyes KM, Fink DS, Ravenell O, Martins SS. Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age. Drug and Alcohol Dependence 2016;166:116-24.

Link: https://www.ncbi.nlm.nih.gov/pubmed/27422762

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Health Insurance Coverage

Intervention Results:

Pregnancy status significantly moderated the relationship between health insurance and tobacco use (p-value≤0.01) and alcohol use (p-value≤0.01). Among pregnant women, being insured was associated with lower odds of alcohol use (adjusted odds ratio [AOR]=0.47; 95% confidence interval [CI]=0.27-0.82), but not associated with tobacco use (AOR=1.14; 95% CI=0.73-1.76). Among non-pregnant women, being insured was associated with lower odds of tobacco use (AOR=0.67; 95% CI=0.63-0.72), but higher odds of alcohol use (AOR=1.23; 95% CI=1.15-1.32).

Buchanan C, Nahhas GJ, Guille C, Cummings KM, Wheeler C, McClure EA. Tobacco use prevalence and outcomes among perinatal patients assessed through an "opt-out" cessation and follow-up clinical program. Maternal and Child Health Journal 2017;21:1790-7.

Link: https://europepmc.org/article/med/28702864

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Person-to-Person Education, Motivational Interviewing, Other Education, Intensive Therapy, Peer Counselor

Intervention Results:

Between February 2014 and March 2016, 533 (10%) current and 898 (16%) former smokers were identified out of 5649 women admitted to the perinatal units. Current smokers reported an average of 11 cigarettes per day for approximately 12 years. Only 10% reported having made a quit attempt in the past year. The majority of smokers (56%) were visited by a bedside tobacco cessation counselor during their stay and 27% were contacted through the IVR system. Those counselled in the hospital were twice as likely (RR 1.98, CI 1.04-3.78) to be abstinent from smoking using intent-to-treat analysis at any time during the 30 days post-discharge.

Campbell KA, Cooper S, Fahy SJ, Bowker K, LeonardiBee J, McEwen A et al. 'Opt-out' referrals after identifying pregnant smokers using exhaled air carbon monoxide: Impact on engagement with smoking cessation support. Tobacco Control: An International Journal 2017;26:300-6.

Link: https://tobaccocontrol.bmj.com/content/26/3/300.long

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Referrals

Intervention Results:

Approximately 2300 women attended antenatal care in each period. Before the implementation, 536 (23.4%) women reported smoking at ‘booking’ and 290 (12.7%) were referred to SSS. After the implementation, 524 (22.9%) women reported smoking at ‘booking’, an additional 156 smokers (6.8%) were identified via the ‘opt-out’ referrals and, in total, 421 (18.4%) were referred to SSS. Over twice as many women set a quit date with the SSS after ‘opt-out’ referrals were implemented (121 (5.3%, 95% CI 4.4% to 6.3%) compared to 57 (2.5%, 95% CI 1.9% to 3.2%) before implementation) and reported being abstinent 4 weeks later (93 (4.1%, 95% CI 3.3% to 4.9%) compared to 46 (2.0%, 1.5% to 2.7%) before implementation).

Chertok IRA, Archer SH. Evaluation of a midwife- and nurse-delivered 5 A's prenatal smoking cessation program. Journal of Midwifery & Womens Health 2015;60:175-81.

Link: https://www.ncbi.nlm.nih.gov/pubmed/25782851

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Motivational Interviewing, Telephone Support, Peer Counselor, Midwife, PROVIDER/PRACTICE, Nurse/Nurse Practitioner

Intervention Results:

Among the 35 women who enrolled in the study, 32 (91.4%) decreased smoking and 3 (8.6%) quit smoking by one month after the intervention. For those who continued to smoke, the average number of cigarettes smoked was reduced from 10 cigarettes per day at baseline to 8 cigarettes per day at one month, 7 cigarettes per day at 2 months, and 6 cigarettes per day by the end of pregnancy. The women further reduced their tobacco exposure by delaying the timing of initiating smoking in the morning and by increasing indoor smoking restrictions.

Coleman-Cowger VH, Mark KS, Rosenberry ZR, Koszowski B, Terplan M. A Pilot Randomized Controlled Trial of a Phone-based Intervention for Smoking Cessation and Relapse Prevention in the Postpartum Period. Journal of Addictive Medicine 2018 May/Jun;12(3):193-200. doi: 10.1097/ADM.0000000000000385.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970014/

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, Enabling Services, Access to Provider through Hotline

Intervention Results:

PPCC was found to be feasible and acceptable to some participants but not all. There were no significant differences in tobacco products per day at 6 months postpartum between groups; however, effect sizes differed at 6 weeks compared with 6 months postpartum. Similarly, there were no significant differences between groups in cessation rate (24% in each group) and past 90-day tobacco use (59 days vs 55 days, for Control and Experimental groups respectively).

Cummins SE, Tedeschi GJ, Anderson CM, Zhu S. Telephone intervention for pregnant smokers: A randomized controlled trial. American Journal of Preventive Medicine 2016;51:318-26.

Link: https://www.ncbi.nlm.nih.gov/pubmed/27056131

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Telephone Support

Intervention Results:

Abstinence was higher for the intervention than the control group at the end of pregnancy (30-day abstinence, 29.6% vs 20.1%; p<0.001); 2 months postpartum (90-day abstinence, 22.1% vs 14.8%; p<0.001); and 6 months postpartum (180-day abstinence, 14.4% vs 8.2%; p<0.001). Cotinine-corrected (≤13 ng/mL) 7-day abstinence rates at the end of pregnancy supported the intervention effect (35.8% vs 22.5%, p<0.001).

Eddy, A, Prileszky, G, Nicoll, K, Barker, R, Anisy, J. ABC by LMC midwives: an innovative intervention to support women to become smoke-free in pregnancy. New Zealand College of Midwives Journal 2015; Issue 51.

Link: https://www.midwife.org.nz/wp-content/uploads/2018/09/Jnl-51-article-6.pdf

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Midwife, Referrals

Intervention Results:

Young and Māori women within this project were more likely to become smoke-free than others. A significant number of the women lived in households with other smokers, which may have made it more difficult for them to become smoke-free. The midwives provided smoking cessation interventions using the ABC to the women with varying frequency; however, the frequency of these interventions did not appear to be related to the likelihood of the women becoming smoke-free. The midwives did not provide ABC at every single visit for every woman; however, for some women it was provided more often than for others.

England L, Tong VT, Rockhill K, Hsia J, McAfee T, Patel D, Rupp K, Conrey EJ, Valdivieso C, Davis KC. Evaluation of a federally funded mass media campaign and smoking cessation in pregnant women: a population-based study in three states. British Medical Journal Open 2017 Dec 19;7(12):e016826. doi: 10.1136/bmjopen-2017-016826.

Link: https://www.ncbi.nlm.nih.gov/pubmed/29259054

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): NATIONAL, Campaign

Intervention Results:

Cessation rates were stable during 2009-2011 but increased at the time Tips 2012 aired and remained elevated. Overall, 32.9% of unexposed and 34.7% of exposed smokers quit by the third trimester (p<0.001). Exposure to Tips 2012 was associated with increased cessation (adjusted OR: 1.07, 95% CI 1.05 to 1.10).

Fallin-Bennett A, Rademacher K, Dye H, Elswick A, Ashford K, Goodin A. Perinatal Navigator Approach to Smoking Cessation for Women With Prevalent Opioid Dependence. Western Journal of Nursing Research 2019 Feb 6:193945918825381. doi: 10.1177/0193945918825381.

Link: https://www.ncbi.nlm.nih.gov/pubmed/30724661

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Navigation, Other Person-to-Person Education, Referrals

Intervention Results:

Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers.

Forinash AB, Yancey A, Chamness D, Koerner J, Inteso C, Miller C, Gross G, Mathews K. Smoking Cessation Following Text Message Intervention in Pregnant Women. Annals of Pharmacotherapy 2018 Nov;52(11):1109-1116. doi: 10.1177/1060028018780448. Epub 2018 Jun 1.

Link: https://journals.sagepub.com/doi/10.1177/1060028018780448

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Telephone Support

Intervention Results:

Of 49 randomized patients, 13 withdrew, and 6 were lost to follow-up. The remaining included 14 texting and 16 SOC patients. eCO-verified cessation was achieved by 57.1% in the texting group versus 31.3% in the control (P = 0.153). Overall, 64.3% of the texting group achieved an eCO below 8 ppm at ≥1 visit versus 37.5% in the control group (P = 0.143). No difference was found in birth outcomes. The study was underpowered because of slow enrollment and high drop-out rates.

Glover M, Kira A, Smith C. Enlisting "Aunties" to support indigenous pregnant women to stop smoking: Feasibility study results. Nicotine & Tobacco Research 2016;18:1110-5.

Link: https://www.ncbi.nlm.nih.gov/pubmed/26253617

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Other Person-to-Person Education, PROVIDER/PRACTICE, Outreach (Provider)

Intervention Results:

The majority of women were Māori, 20-30 years old, had their first cigarette within 30 minutes of waking and 58% had not tried to quit during the current pregnancy. Of the participants who completed a follow-up interview 33% had stopped smoking while they were pregnant and 57% had cut down. There was an increase at follow-up of people who had used cessation support or products.

Griffis H, Matone M, Kellom K, Concors E, Quarshie W, French B, Rubin D, Cronholm PF. Home visiting and perinatal smoking: a mixed-methods exploration of cessation and harm reduction strategies. BioMed Central Public Health 2016 Aug 11;16(1):764. doi: 10.1186/s12889-016-3464-4.

Link: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3464-4

NPM: 14-1: Smoking During Pregnancy
Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Motivational Interviewing, Referrals, Educational Material

Intervention Results:

A program effect was seen for smoking cessation such that clients who smoked less than ten cigarettes per day and those who smoked 20 or more cigarettes per day during the first trimester were more likely to achieve third trimester cessation than comparison women (p <0.01 and p = 0.01, respectively). Only for heavy smokers (20 or more cigarettes during the first trimester) was there a significant reduction in number of cigarettes smoked by the third trimester versus comparison women (p = 0.01). Clients expressed the difficulty of cessation, but addressed several harm-reduction strategies including reducing smoking in the house and wearing a smoking jacket. Clients also described smoking education that empowered them to ask others to not smoke or adopt other harm reducing behaviors when around their children.
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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.