Effectiveness of a large prenatal tobacco reduction program
Initial Award Abstract
Smoking during pregnancy is the most important modifiable cause of poor birth outcomes in the United States. Many programs have been developed to help women quit smoking during pregnancy, and the most successful combine educational materials with systematic advice from health care providers. In March of 1999, three large health care systems in San Diego County created a large pregnancy-based smoking reduction program aimed at reaching half of all women delivering in the county. Called the Partnership for Smoke-Free Families Program (PSF), this program has screened and educated over 53,000 pregnant women. Women who are still smoking at the time of their first prenatal visit are phoned by trained stop-smoking counselors, and prenatal care providers are trained to discuss smoking with women at each prenatal visit. PSF also sends targeted mailings to women who quit smoking when they found out they were pregnant, because these women are at high risk for smoking relapse before and after delivery. The PSF program has been expanding in San Diego County, and could become a model for the rest of the state, or even other states.
We will objectively evaluate the PSF program to determine whether women in the program smoke less and stay quit longer than women who are not in the program. A previous study of tobacco exposure during pregnancy (Project Baby’s Breath, or PBB) has coincided with several years of the PSF program’s operations. Linking the information PSF already collects during pregnancy and at delivery with the information and specimens collected by the PBB study allows us to objectively determine whether the PSF program reduces active smoking levels among women who smoked before pregnancy. We will measure tobacco exposure using laboratory analysis for cotinine, a nicotine metabolite, in 2,300 stored specimens collected at mid-pregnancy or at the time of delivery. We will compare rates of quitting, levels of exposure, and smoking relapse during pregnancy between approximately 650 PSF program participants and a control group of similar size. By examining the cotinine levels in specimens of 500 women who claimed to be non-smokers on the PSF enrollment form, we will be able to inform PSF about the number of smokers they may not be reaching during pregnancy.
The results of this study will help guide PSF in making program improvements, and will help guide policy and decision makers in the revision of other existing programs as well as in the planning of future of programs aimed at reducing tobacco exposure during the prenatal period. |