Telephone Counseling for Pregnant Smokers

Study Overview
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Brief Summary
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This purpose of the study was to investigate the efficacy of telephone counseling to help pregnant women quit smoking. The investigators tested two hypotheses: 1) telephone counseling increases the overall cessation rate during pregnancy, and 2) the counseling effects can be maintained postpartum.

Detailed Description
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Smoking during pregnancy increases the risk of low birth weight, premature delivery, fetal and infant death, and children's developmental problems. It is also associated with significant economic costs. Telephone cessation quitlines have been suggested as one good way to reach pregnant smokers. This randomized controlled trial was embedded into a free statewide telephone cessation quitline in California. The primary component of the intervention was telephone counseling using a structured protocol developed specifically for the pregnant population. The counseling consisted of nine counseling sessions. A secondary component of the intervention was the mailed materials. Following enrollment in the study all subjects (control and intervention) received a self-help quit kit for pregnant smokers and fact sheets on second-hand smoke and additional tips for quitting while pregnant. Subjects in the counseling intervention group received five additional mailings. These mailings were designed to remind them of their commitment to quitting and of the presence of counseling support if they needed help. Prior to 36 weeks gestation (in the third trimester), 2-months postpartum, and 6-months postpartum we conducted a brief telephone survey to assess smoking status. The information obtained allowed us to determine 30-day prolonged abstinence rates. Prior to 36 weeks gestation (in the third trimester), the investigators sent a kit and requested saliva samples be mailed back to biochemically verify smoking status by testing for cotinine and nicotine byproducts.

Official Title
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Telephone Counseling for Pregnant Smokers

Conditions
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Smoking

Intervention / Treatment
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* Behavioral: Telephone counseling
* Behavioral: Self-help materials


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Current smoker willing to quit within one month Recent quitters First time quitline caller Less than 27 weeks gestation English and/or Spanish speaking Valid phone number Valid address Gave consent to participate in study and evaluation Exclusion Criteria: Active psychiatric disorder Substance or alcohol abuse Had been in recovery from alcohol or other substances for less than 6 months Planned to use pharmacotherapy Insufficient contact information

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Materials<br>Self-help materials mailed to subjects home. | Behavioral: Self-help materials<br>* All subjects received a self-help quit kit for pregnant smokers and fact sheets on second-hand smoke and additional tips for quitting while pregnant. Subjects in the counseling intervention group received five additional mailings. These mailings were designed to remind them of their commitment to quitting and of the presence of counseling support if they needed help. Mailings included a pamphlet on pregnancy facts, a refrigerator magnet with the quitline number, and a social support planning worksheet that were sent at 4.5 months, 6 months, and 7.5 months gestation, respectively. They also received a congratulatory card soon after the birth and a brochure with tips for parenting newborns that was sent at one month postpartum.<br>|
| Experimental: Telephone Counseling and Materials<br>Subjects received up to 9 telephone counseling calls plus self-help quit kit and 5 additional mailings | Behavioral: Telephone counseling<br>* Subjects randomized into the telephone counseling condition received one comprehensive pre-quit call lasting about 45 minutes; five follow-up calls during the pregnancy, scheduled according to the risk of relapse after the quit attempt (1, 3, 7, 14, and 30 days after the quit date) one 30-minute pre-birth call scheduled after 36 weeks gestation and two additional follow-up sessions scheduled for 14 and 28 days after the baby's birth. The counseling used a proactive calling procedure in that counselors made all the calls based on agreed-upon dates with the clients. This proactive approach aimed to foster a positive counseling relationship, provide accountability, and create opportunities to address wavering motivation, reduce attrition, and minimize relapse.<br>Behavioral: Self-help materials<br>* All subjects received a self-help quit kit for pregnant smokers and fact sheets on second-hand smoke and additional tips for quitting while pregnant. Subjects in the counseling intervention group received five additional mailings. These mailings were designed to remind them of their commitment to quitting and of the presence of counseling support if they needed help. Mailings included a pamphlet on pregnancy facts, a refrigerator magnet with the quitline number, and a social support planning worksheet that were sent at 4.5 months, 6 months, and 7.5 months gestation, respectively. They also received a congratulatory card soon after the birth and a brochure with tips for parenting newborns that was sent at one month postpartum.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 30 days prolonged abstinence | Conducted a brief telephone survey to assess smoking status. The information obtained allowed us to determine 30-day prolonged abstinence rates. | 6-months postpartum | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of smokers making a 24-hour quit attempt | During evaluation call subjects were asked if they had made a quit attempt that lasted at least 24 hours. | <36 weeks gestation | 
| Relapse curve based on quit attempt | Kaplan-Meier analysis on the quit attempts over a 6 month period. | Seven months post enrollment | 
| Percentage of smokers making a 24-hour quit attempt | During evaluation call subjects were asked if they had made a quit attempt that lasted at least 24 hours. | 2-months postpartum | 
| Percentage of smokers making a 24-hour quit attempt | During evaluation call subjects were asked if they had made a quit attempt that lasted at least 24 hours. | 6-months postpartum | 
| 7-day cotinine verified abstinence | Subjects were asked to submit a saliva sample. This sample was sent to a laboratory to test the cotinine level. | <36 weeks gestation | 
| 30 days prolonged abstinence | Conducted a brief telephone survey to assess smoking status. The information obtained allowed us to determine 30-day prolonged abstinence rates. Safety Issue? (FDAAA) No | <36 weeks gestation | 
| 30 days prolonged abstinence | Conducted a brief telephone survey to assess smoking status. The information obtained allowed us to determine 30-day prolonged abstinence rates. Safety Issue? (FDAAA) No | 2-months postpartum | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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telephone counseling