A Pregnant Woman's Self-Help Guide to Quit Smoking - Healthcare Social Programs That Work

Evidence Rating:

Suggestive Tier

Highlights

Program:

In this program, health counselors in public maternity clinics teach pregnant women how to use a 7-10 day self-directed smoking cessation guide. The program costs approximately $16 per patient and is provided as a supplement to clinics’ usual care.
Evaluation Methods:

This program has been evaluated in six well-conducted randomized controlled trials (RCTs).
Key Findings:

A sizable increase in the quit rate: 13.9% of women assigned to the program quit smoking in the last 4-5 months of their pregnancy, compared with 8.3% of the women assigned to the control group. In almost all of the RCTs, these effects were statistically significant.
Other:

One limitation in the evidence is that none of the studies reported on birth outcomes (e.g., miscarriage rates, birth weight, gestational age) or early childhood outcomes (e.g., cognitive development, health). Thus, the final impact on child well-being is unknown – and, specifically, whether smoking cessation during the second half of pregnancy (after mothers had smoked during the first half of pregnancy) improves child well-being in a meaningful way.

This educational program for pregnant smokers was provided by health counselors in public maternity clinics. It consisted of a 10-20 minute session during which counselors taught women how to use a 7-10 day self-directed smoking cessation guide (A Pregnant Woman’s Self-Help Guide to Quit Smoking). The program cost approximately $16 per patient (2017 dollars), and was provided in addition to clinics’ usual care, which, in the study clinics described below, typically consisted of brief discussion of the risks of smoking during a nurse-led prenatal class, educational pamphlets, and information on local resources providing quitting assistance.

The Guide is currently out-of-print; the author and program developer is Richard Windsor.

To see our full evidence summary:

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Top Tier

Programs shown in well-conducted RCTs, carried out in typical community settings, to produce sizable, sustained effects on important outcomes. Top Tier evidence includes a requirement for replication – specifically, the demonstration of such effects in two or more RCTs conducted in different implementation sites, or, alternatively, in one large multi-site RCT. Such evidence provides confidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original studies.

Near Top Tier

Programs shown to meet almost all elements of the Top Tier standard, and which only need one additional step to qualify. This category primarily includes programs that meet all elements of the Top Tier standard in a single study site, but need a replication RCT to confirm the initial findings and establish that they generalize to other sites. This is best viewed as tentative evidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original study.

Suggestive Tier

Programs that have been evaluated in one or more well-conducted RCTs (or studies that closely approximate random assignment) and found to produce sizable positive effects, but whose evidence is limited by only short-term follow-up, effects that fall short of statistical significance, or other factors. Such evidence suggests the program may be an especially strong candidate for further research, but does not yet provide confidence that the program would produce important effects if implemented in new settings.

References

Study 1:

Windsor, Richard A., Gary Cutter, Joyce Morris, Yoland Reese, Brynda Manzella, Edward E. Bartlett, Carole Samuelson, and Debra Spanos. “The Effectiveness of Smoking Cessation Methods for Smokers in Public Health Maternity Clinics: A Randomized Trial.” The American Journal of Public Health, 1985, vol. 75, pp. 1389-1392.

Study 2:

Windsor, Richard A., John B. Lowe, Laura L. Perkins, Dianne Smith-Yoder, Lynn Artz, Myra Crawford, Kim Amburgy, and Neal Richard Boyd. “Health Education for Pregnant Smokers: Its Behavioral Impact and Cost Benefit.” The American Journal of Public Health, February 1993, vol. 83, no. 2, pp. 201-206.

Study 3:

Hartmann, Katherine E., John M. Thorpe, Laurie Pahel-Short, and Matthew A. Koch. “A Randomized Controlled Trial of Smoking Cessation Intervention in Pregnancy in an Academic Clinic.” Obstetrics and Gynecology, 1996, vol. 87, pp. 621-626.

Study 4:

O’Connor, Annette M., Barbara L. Davies, Corinne S. Dulberg, P. Lynn Buhler, Claudette Nadon, Beverly H. McBride, and Ronald J. Benzie. “Effectiveness of a Pregnancy Smoking Cessation Program.” Journal of Obstetrics, Gynaecology, and Neonatal Nursing, 1992, vol. 21, pp. 385-392.

Study 5:

Valbo, Annelill and Gro Nylander. “Smoking Cessation in Pregnancy: Intervention Among Heavy Smokers.” Acta Obstetrica et Gynecogica Scandanavia, 1994, vol. 73, pp. 215 – 219.

Study 6:

Windsor, Richard A., Lesa Woodby, Thomas Miller, and Michael Hardin. “Effectiveness of Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Methods in Medicaid-Supported Prenatal Care: Trial III.” Health Education & Behavior, 2011, vol. 38, no. 4, pp. 412-422.

Other Studies:

Gielen, Andrea C., Richard A. Windsor, Ruth R. Faden, Patricia O’Campo, John Repke, and Mary V. Davis. “Evaluation of a Smoking Cessation Intervention for Pregnant Women in an Urban Prenatal Clinic.” Health Education Research, 1997, vol. 12, pp. 247-254.

Hjalmarson, A. I. M., L. Hahn, and B. Svanberg. “Stopping Smoking in Pregnancy: Effect of a Self-Help Manual in a Controlled Trial.” British Journal of Obstetrics and Gynaecology, 1991, vol. 98, pp. 260-264.

A Pregnant Woman’s Self-Help Guide to Quit Smoking

Highlights

Program:

Evaluation Methods:

Key Findings:

Other:

References

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