Page 89 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

Intervention Description
Pediatric office-based smoking intervention, delivered by a pediatrician. Implemented during ‘well baby’ office visits at 2 wk, 2, 4 and 6 mo pp. Duration of counseling 1-2 min.
Hospital packet containing written information about passive smoking and a letter advising them to quit + oral and written advice.
Content of advice: adverse health effects of passive smoking, hints for quit strategies, role modeling and a letter to the fathers. Videotape: potential health effects of passive smoking, benefits of quitting. Brief discussion about amount smoked, barriers to quitting and results of past quit attempts. Smokers were asked whether they were willing to set a quit date. If mothers expressed a willingness to set a quit date, they were given the Freedom From Smoking materials developed by the American Lung Association and a list of local resources for assistance in quitting. They were encouraged to follow through and a project quit kit was distributed. Quitters were encouraged to stay quit.
I: one 15-min in-person counseling session delivered by trained study staff working from adapted materials and messages specifically tailored for parental smokers (available at: www.ceasetabacco.org); offer of enrollment in a proactive state-of-the-art telephone counseling session (QuitWorks, the Massachusetts statewide quitline) and letters faxed to the newborn’s pediatrician, parents’ primary care provider and mothers’ obstetrician indicating the parents’ tobacco use status and their readiness to quit and recommending useful strategies to facilitate parental cessation, the need for ongoing support and medication prescription when appropriate. The overall strategy was based on the 5A model177 178 and tailored to the circumstances of the parental smoker in the hospital setting when their child is hospitalized.
Baseline values
Smokers: n=1478 Quitters: n=858
Weight Loss
Smokers: at 6 mo pp, 5,9% of the women in the I group reported a 7-d abstinence compared to 2.7% of the women in the C group (p<0.01). OR 1.82, 95% CI 1.02-3.25.
Quitters: At 6 mo pp, 45% of the I group reported smoking relapse, compared to 55% in the C group, OR 1.56, 95% CI 1.16-2.10.
3.1 Effect of Postpartum Lifestyle Interventions| 87
Smokers:
I: 69% (63% female)
C: 62% (54% female) Median number of cigarettes per d:
I: 4.4
C: 5.0
At 3 mo postpartum self-reported 7- d point abstinence decreased from 31% to 25% among I parents vs 38% to 23% among C subjects (effect size 9.4%, NS). Among current smokers at baseline who were reached at follow-up (n=36), self-reported cotinine-confirmed 7-d abstinence rates at follow-up were 9% in the I group and 3% in the C group (NS). Among mothers who were smokers at baseline, 10% in the I group and 5% in the C group self-reported 7-d abstinence at the 3 mo follow-up (NS).