The long-term goal of this research is to reduce tobacco-related disparities in maternal and infant health outcomes by improving smoking cessation and relapse prevention interventions for minority pregnant and postpartum women, who have been significantly underrepresented in smoking cessation research. This study will examine the feasibility and efficacy of a prize-based contingency management approach for increasing smoking cessation and preventing relapse among socioeconomically disadvantaged minority pregnant smokers. First, the intervention will be pretested with 10 pregnant low-income minority smokers and then refined based on acceptability survey and focus group data. Next, a pilot study will be conducted. 60 highly disadvantaged minority women, recruited from the outpatient obstetric clinics at a large teaching hospital, who report daily smoking and who meet other eligibility criteria (e.g., 18 years or older; < 28 weeks gestational age) will be enrolled ad randomized to one of two study conditions: 1) Standard Psychoeducational Intervention (6- week, individually-administered, pregnancy-specific Quit Smoking Now curriculum, as currently implemented in the clinic; QSN-SP); 2) Standard Psychoeducational Intervention plus Contingency Management (provision of incentives contingent on biochemically-verified abstinence; QSN-CM). Abstinence monitoring via expired carbon monoxide and salivary continues levels will occur in both groups beginning on the first quit day and continuing through 3-months postpartum. Only participants in the QSN-CM group will be reinforced for biochemically-verified abstinence with chances to win prizes ranging in value from approximately $1 to $100 ('fishbowl' or 'prize bowl' method). Primary study outcomes include: intervention attendance and completion; and continuous, prolonged and point prevalence tobacco abstinence (self-report with biochemical verification). Secondary outcomes include: maternal and infant health outcomes (e.g., gestational age; infant birth weight, length and head circumference; delivery/neonatal complications; infant growth and respiratory health). The study will also examine factors (e.g., depression, stress) influencing treatment response. Outcomes will be assessed through follow-up research exams (delivery and 6-months postpartum) and hospital chart reviews. Results should advance scientific knowledge regarding effective methods for promoting and maintaining smoking abstinence among pregnant disadvantaged women and provide preliminary feasibility and efficacy data needed to support a larger randomized controlled trial.
Prenatal smoking has been associated with numerous adverse pregnancy and delivery complications. Socioeconomically disadvantaged, minority women are less likely to quit smoking, are more likely to relapse after cessation and may suffer greater health consequences, for themselves and their baby, as a result of smoking. The proposed project seeks to reduce disparities in tobacco-related maternal and infant health outcomes by improving smoking cessation and relapse prevention interventions for low-income, minority pregnant and postpartum women.
