Smoking and second hand smoke exposure are causally related to cancer. Pregnancy is a naturally occurring life transition that can increase motivation for making changes in pregnant womens' smoking behaviors and that of their household members.

Overarching goals of this project are to increase naturalistic rates of cessation around pregnancy in pregnant women and their household members, to increase the likelihood of longer-term abstinence in the postpartum period, and to improve on pregnancy-related naturalistic changes in implementation of household smoking bans. These efforts may result in overall decreases in smoking, given evidence that the rate of long-term smoking cessation is ...

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Need: Smoking and second hand smoke exposure are causally related to cancer. Pregnancy is a naturally occurring life transition that can increase motivation for making changes in pregnant womens' smoking behaviors and that of their household members.

Overarching goals of this project are to increase naturalistic rates of cessation around pregnancy in pregnant women and their household members, to increase the likelihood of longer-term abstinence in the postpartum period, and to improve on pregnancy-related naturalistic changes in implementation of household smoking bans. These efforts may result in overall decreases in smoking, given evidence that the rate of long-term smoking cessation is between 2 to 4 times greater in women who quit during pregnancy compared to mothers who continue to smoke.

In 2013, the percentage of live births to a woman who smoked during pregnancy in Northeast Texas was more than three times that of births in Texas overall. Survey data from patients in in low-income clinics in Northeast Texas indicate that less than 10% are provided assistance in quitting. The proposed program will address barriers to treatment receipt by establishing system-wide assessment of tobacco use in clinical settings that serve low-income pregnant women, and proactive automatic referral of pregnant smokers and pregnancy-related quitters to intensive evidence-based telephone counseling services, a smartphone smoking cessation and relapse prevention app, and a minimal intensity smoke free homes intervention.

We will work in 12 WIC and FQHC clinics in Northeast Texas to implement an evidence-based system intervention to establish automatic system-wide assessment of tobacco use and smoking in the home, and automatic proactive referral to program services. This will be accomplished by integrating an Android app assessment instrument into clinic work flows. All women who consent to provide contact information will receive proactive calls to enroll in counseling and will be provided with evidence-based pregnancy and postpartum focused self-help tobacco cessation materials. Women who consent to download the smartphone app will be provided with motivational messages and tips to assist with smoking cessation, relapse prevention and establishment of home smoking bans. They will also have the opportunity to enroll in the counseling and smoke free homes intervention using an app link; and to share the app link with household family members who smoke, who will be allowed to enroll in the counseling services.

Intensive, telephone counseling will be based on a motivational, behavioral and pregnancy-focused health education intervention from a randomized trial conducted by the program director, which was associated with high rates of prenatal abstinence (39%). This intervention will be adapted to increase feasibility of treatment delivery and to provide continued counseling during the first 4 postpartum months. Counseling will be delivered by bachelor level tobacco treatment specialists in the MD Anderson Tobacco Treatment Program.

Women with current psychiatric disorders will be triaged to a licensed mental health practitioner and tobacco treatment specialist, who will incorporate cognitive behavioral strategies to address psychiatric symptoms as barriers.

Goals are: 1) establish proactive automatic referral of pregnant smokers, pregnancy-related quitters and household smokers to the smoking-related services in 12 FQHC and WIC clinics in northeast Texas; 2) provide access to intensive, tailored, evidence-based tobacco cessation treatment and relapse prevention services; and access to app-based motivational interventions during the prenatal and postpartum periods, and; 3) provide access to an evidence-based minimal smoke free homes intervention during the prenatal and postpartum periods.

The majority of tobacco cessation services offered to pregnant women rely on busy medical personnel for delivery or are brief clinic-based interventions that have yielded only modest effects and low abstinence rates. The proposed program is innovative in offering a telephone-delivered, intensive counseling approach in both the prenatal and postpartum periods, delivered by counselors well prepared to address both tobacco and the numerous psychosocial challenges with which women may present, which will likely produce higher abstinence rates; offering a less intensive smartphone app to women who decline to enroll in the counseling services; and addressing smoking in the home. In addition, the program’s emphasis on motivational enhancement approaches at each level of outreach is innovative.

The project will provide a model for delivery of effective smoking interventions in pregnant women during the prenatal and postpartum period, which could be expanded to additional WIC and FQHC clinics in Northeast and other regions of Texas.

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