Adapting Smoking Relapse Prevention Materials for Pregnant and Postpartum Women

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Adapting Smoking Relapse Prevention Materials for
Pregnant and Postpartum Women

• Gwendolyn P. Quinn, Ph.D.

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Pregnancy and Smoking

• The majority of pregnant women (except for this
  one in the photo) are aware that smoking has
  deleterious effects on unborn children

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Pregnancy and Smoking

• Smoking is associated with ectopic pregnancy,
  premature birth, low-birth weight and placental
  complications
  
• Health risks to the unborn child of a smoker
  remain a factor after birth postpartum smoking
  is linked to sudden infant death syndrome, ear
  infections, and asthma

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Pregnancy and Smoking

• While most mothers are aware of the dangers of
  smoking during pregnancy, less are aware of how
  these health risks prevail after the birth of
  their child.
• Pregnant women are often highly motivated to quit
  smoking during the pregnancy and tend to report
  an easier time quitting than non-pregnant women

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Pregnancy and Smoking

• Because pregnant women report having an easier
  time quitting (higher motivation and reduced
  cravings and withdrawal symptoms) they tend to
  quit spontaneously and without a plan.
• This lack of planning may account for the relapse
  rate of 70-85 among post-partum women

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Pregnancy and Smoking

• The purpose of this study was to gain formative
  research data on the barriers and facilitative
  factors of using existing, theoretically based,
  empirically supported relapse prevention
  materials, as they were adapted to meet the
  unique needs of pregnant and postpartum women.

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Forever Free

• The Forever Free relapse prevention program is a
  series of eight empirically based booklets,
  validated in two clinical trials to reduce
  relapse among adult former smokers.
• Brandon, T. et al. Efficacy and
  cost-effectiveness of a minimal intervention to
  prevent smoking relapse Dismantling the effects
  of content versus contact. J consult Clin Psychol
  2004 72 (5) 797-808.

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Forever Free

• The Forever Free materials are distinct in that
  their focus is not on smoking cessation, but
  rather on preventing relapse among former smokers
  who have already quit or attempted to.

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Methods

• Semi-structured interviews were conducted with 38
  women who were
  
• 18 or older
• A smoker for at least a year
• Stopped smoking before or during pregnancy
• Been abstinent at least two months during
  pregnancy
  
• No sooner than 5 months pregnant and no more than
  8 months postpartum
  

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Recruitment

• Recruiting women for the study was a challenge.
  We placed ads in newspapers, posted flyers in
  grocery and baby stores, worked through local
  health depts.,OB and pediatrician offices.
• Women were reluctant to admit to being a smoker
  at any time during the pregnancy
  

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Participants

• The resulting sample was comprised of 22 white, 5
  Asian, and 10 black women who represented the
  three categories of
  
• (PA) Pregnant Abstinent at least 6 months
  pregnant and not smoking
  
• (PPA) Postpartum Abstinent within 8 months
  postpartum and not smoking
  
• (PPR) Postpartum Relapsed within 8 months
  postpartum and relapsed to smoking

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Semi-structured interviews

• Qualitative interviews were conducted in private
  rooms of the research office, or at the
  participants homes. Child care and 25
  compensation was provided
• The interview guide was developed based on common
  cessation and relapse factors in the literature
  as well as a review of the Forever Free booklets.
  One of the goals of the project was to ask the
  women for input in adapting the existing
  materials to meet the needs of pregnant and
  postpartum women

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Data Analysis

• Verbatim transcripts of interviews were initially
  hand coded and later managed with Ethnograph
  
• Content analysis, using a template analysis plan,
  was performed to identify key themes in the
  womens beliefs and experiences
  
• Data were used to edit and restructure the
  existing Forever Free materials and create
  tailored messages for pregnant and postpartum
  women

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Results

• Findings showed varied results across the three
  groups in terms of the definition of quitting
  smoking versus making a decision to quit
  
• Overall, women in all groups experienced conflict
  about their identities as new parents or parents
  to be in relation to their new social roles and a
  smoke-free life.

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Results

• Feedback about needed changes to the booklets did
  not vary across the three groups.
  
• Suggested names for the new booklets included
  Babys Breath, New Beginnings, Forever Free for
  Baby and Me
  
• The majority said they would expect to be offered
  the booklets by their health care provider and
  would be reluctant to use them if distributed
  from another source

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Sample Results
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Results
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Results
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Results
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Results

• All women liked the layout of the booklets and
  found content useful
  
• Respondents requested additional information
  about weight gain, dealing with social situation,
  moodiness, cravings

• Women said that information specific to each
  trimester and the postpartum period would be
  helpful the issues are different at each stage
  
• Women requested personal stories or case
  histories of other pregnant women who were
  successful at remaining smoke free
  

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Results

• The most appealing messages included information
  about
  
• Costs of smoking
• Behavioral and mental coping skills
• Preparing for triggers to smoking
• Preparing for differences in withdrawal during
  pregnancy and postpartum period
  
• Reminders of reasons to quit smoking for their
  own health as well as the child

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Conclusions

• Results underscore those found in other studies
  women often suspend smoking during pregnancy
  
• Women tend to not make a plan for long-term
  smoking cessation, either intending to resume
  after baby is born or assuming that the ease of
  remaining smoke-free during pregnancy will
  continue through postpartum period

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Conclusions

• The focus of the project is on preventing relapse
  among this population and adapting the Forever
  Free materials for this group
  
• To this end, attention must be paid to the
  language and definitions used by women describe
  to quitting
  
• The role of the spouse/partner is also a key
  factor
  
• Preparing women for the different potential
  relapse situations they may encounter in the
  postpartum period is also essential

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End

• A clinical trial to test the efficacy of the
  booklets with this population is on-going.
  Results will be available by mid 2007
  
• The research was supported by NCI grant RO1 CA
  94256. Copies of the Forever Free for Baby and Me
  booklets may be requested from Dr. Thomas
  Brandon brandont_at_moffitt.usf.edu
• This presentation is based on the article

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• Quinn, G., Ellison, B., Meade, C., Roach, N.,
  Lopez, E., Albrecht, T., Brandon, T. (2005).
  Adapting Smoking Relapse Prevention Materials for
  Pregnant and Postpartum Women Formative
  Research
• For details about this presentation or the
  article please contact
  
• Gwendolyn P. Quinn, Ph.D.
• H.L. Moffitt Cancer Center and Research Institute
  
  
• University of South Florida, College of Medicine
  quinng_at_moffitt.usf.edu