Problems related to smoking during pregnancy are entirely preventable. The imminent danger of smoking to mothers (i.e. abruptio placentae) and unborn children (i.e. low birthweight) calls for prompt and intensive intervention. Reasons for continued smoking during pregnancy vary by age and income. In this proposed study's low-income population, the most likely group to smoke throughout pregnancy, women suffer from stressful events in their lives, which they cite as difficult barriers to smoking cessation. Social support has been shown to be beneficial in general for coping with problems. AHCPR smoking guidelines call for a social support component in cessation programs that is delivered by healthcare providers. Unfortunately, the guidelines' recommendations for social support focus narrowly on smoking related problems alone. For low-income pregnant women, this tight focus means healthcare providers may not touch on the very topics that are key to their quitting smoking. Nurses' skills in assessment and providing support are extremely well matched to delivering the help women need to quit smoking during pregnancy. This study's primary aim is to determine whether a combination of an established smoking cessation educational program for pregnant women and a nurse- delivered telephone social support intervention (weekly telephone calls as well as having 24-hour pager access to research nurses) will increase pregnant womens' smoking cessation or smoking reduction rates. A sample of pregnant women who smoke will be recruited from WIC clinics in central Missouri. The outcome measure will be saliva cotinine values collected repeatedly every month from enrollment in the study until the last month of pregnancy. A secondary aim of the study will be to determine the prevalence of relapse among the women who quit smoking, when the relapse occurs, and associated stressors. A randomized controlled trial of four groups will be conducted using a repeated measures 2x2 factorial design with two levels of education (Present or Absent) and two levels of nurse-delivered telephone social support (Present or Absent). To determine significant group differences in quit rates, Chi-square analysis for each month will be used. A fixed-effects repeated measure ANOVA will be used to determine significant group differences in reduction in smoking and survival analysis will detect if there are significant group differences in time to relapse.
