Smoking during pregnancy increases women's risk of complications of pregnancy and numerous birth outcomes. Two-thirds of women smokers continue to smoke during pregnancy, with particularly high rates of smoking among low income and less educated women. For the majority of women, pregnancy occurs in the context of an intimate relationship that pregnant women report as their primary source of support. However, naturally occurring partner support may not be enough to assist pregnant smokers with cessation, particularly when the partner is a smoker. The proposed study is a five year randomized trial to evaluate the incremental improvement of providing a part-assisted support adjunct to state-of-the-science self-help smoking cessation interventions for pregnant smokers. Ft. Bragg military base located in Fayetteville, NC was selected as the study site because of high smoking rates, high birth rates and the majority of women who receive prenatal care are married to military personnel. Three intervention conditions will be tested in an additive design. Eligible couples who are receiving prenatal care at Ft. Bragg/Womack Army Medical Center will be identified from automated appointment logs and recruited to participate. Couples who agree (n=700) will be randomized to: (1) provide advice and a self-help booklet (usual care prototype, n=233); (2) self-help guide and relapse prevention kit plus pre-and postpartum telephone counseling (enhanced self-help, n=233); or (3) enhanced self-help plus a partner-assisted support intervention that includes a couple contact session and tailored serialized written materials plus cessation materials for partner smokers (partner-assisted, n=233). Participants will be surveyed at baseline, 32 weeks of pregnancy, and 8 weeks, 6 and 12 months postpartum. Self reported smoking status will be biochemically validated late in pregnancy and at the 12 month follow-up. The primary outcomes of interest will be rates of smoking cessation among pregnant women and levels of perceived partner support for cessation at all follow-ups.
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