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Smoking Cessation & Pregnancy . Susan A. Albrecht, PhD, RN Donna D. Caruthers, PhD(c), RN University of Pittsburgh School of Nursing Supported by: National Institute of Nursing Research # RO1-NR03233. Presentation Overview.

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smoking cessation pregnancy

Smoking Cessation & Pregnancy

Susan A. Albrecht, PhD, RN

Donna D. Caruthers, PhD(c), RN

University of Pittsburgh

School of Nursing

Supported by: National Institute of Nursing Research

# RO1-NR03233

presentation overview
Presentation Overview
  • Significance of smoking in the obstetrical patient
  • Brief overview of findings for smoking cessation during pregnancy
  • Review of study findings for smoking cessation with pregnant teenagers
  • Implications for future work


  • 25% of adults smoke regularly
  • 12.3% pregnant adults smoke during pregnancy (Matthews, NVSS, 49:7, 2001)


  • 1/3 of all teens smoke
  • Teens at risk

Rural adolescents & Inner city females

Highest rates of smoking in pregnancy (26%)

(Matthews, NVSS, 49:7, 2001)

teen smoking pregnancy
Teen Smoking & Pregnancy


Age (Years)

Allegheny County, 1995

teen health risks
Teen Health Risks
  • Respiratory system damage
  • Nicotine Addiction
  • Risk for other drug use (Surgeon General, 1994)
  • Impairs physical endurance & performance
  • Decreased overall health with increases in healthcare visits  (Arday,et al., Am J of Health Promotion,1995;10(2): 111-116)
health risks teen pregnancy
Health Risks – Teen Pregnancy
  • U.S  Highest teenage pregnancy rate of developed countries. (CDC, 1999)
  • Low birth weight due to poor prenatal nutritional intake
  • Preterm delivery
  • Obstetrical risks double with teen smoking

(ACOG Educational Bulletin, 1997;240.)

obstetrical health risks smoking
Obstetrical Health Risks & Smoking
  • Ectopic pregnancy
  • Placenta previa
  • Abruptio placenta
  • Preterm delivery
  • Perinatal mortality
  • Low birth weight – 2 times greater in smokers
  • Intrauterine growth retardation

(ACOG Educational Bulletin, 1997;240.)

fetus and infant health risks
Fetus and Infant Health Risks
  • Low birth weight
  • Sudden Infant Death Syndrome (SIDS)
  • Respiratory illnesses Pulmonary, Otitis Media, Asthma
  • School problems Lower scores on spelling & reading tests Decreased attention Risk for hyperactive behavior
  • Increased Hospitalizations

(Pollack, H.A., Am J Public Health, 2001; 91(3) & ACOG Educational Bulletin, 1997;240.)

background pregnant adult
Background – Pregnant Adult

Smoking during pregnancy: Is it a temporary act?

At least 1/3 of all women who quit during pregnancy relapse before delivery. (Ershoff, 1995, Am J Prev Med)

Most women will relapse within 12 months of delivery. (Surgeon General, 2001)

2000 clinical practice guidelines
2000 Clinical Practice Guidelines
  • Guidelines state health care providers must screen and address for tobacco consumption with every smoker at every encounter
  • Treatments as brief as three minutes are effective
  • Use Five A’s to guide your efforts
  • Use Five R’s to guide your efforts with patients unwilling to quit
background pregnant adult11
Background – Pregnant Adult

Treatment types investigated

  • Harm Reduction – Exposure from spouse
  • Support for spontaneous quitters
  • Prenatal cessation programs
  • Relapse prevention programs

-Prenatal delivery

-Post delivery - telephone counseling

predictors of relapse
Predictors of Relapse

Adult Pregnant Smokers

  • Dependence/Tobacco use
  • Passive exposure (spouse)
  • Not breast feeding
  • Self-efficacy
  • Education

Tobacco Control 2000, 9; supplement

another approach
Another Approach

Extending research to include pregnant teen smokers

developmental theory
Developmental Theory

Jessor’s Theory of

Problem Behavior Development

  • Teens engaging in one type of problem behavior are more inclined to participate in other problem behaviors.
  • Problem behaviors (e g. Smoking) focus on the role of peers.
problem behavior theory
Problem Behavior Theory

Personality System

Social Environment


Behavior System

Perceived Environment System

Adapted from Jessor, Donovan, & Costa (1991)

treatment efficacy
Treatment Efficacy
  • What are the short and long term differences in smoking behaviors among pregnant adolescents randomly assigned to either:

Teen FreshStart (TFS),

Teen FreshStart with Buddy (TFS-B), or

Usual Care (UC)?

effect of booster sessions
Effect of Booster Sessions
  • What is the effect of booster sessions on smoking behavior 1 year after study entry?

Booster sessions were anticipated to increase cessation rates as measured by self-report and saliva cotinine when controlling for cessation treatment (TFS & TFS-B).

predictors of relapse19
Predictors of Relapse
  • Does a model consisting of baseline characteristics of social environment, personal, and perceived environmental factors predict adolescent smoking at 12 months following study entry(T4).

Independent Variables

  • Treatment Group Assignment
  • Telephone Booster Sessions

Dependent Variables

  • Smoking Abstinence (Objective & Subjective)

1. saliva cotinine & carbon monoxide

2. self-report of smoking behavior

data collection
Data Collection
  • Baseline – T1
  • Following 8 week intervention – T2
  • 6 weeks postpartum – T3
  • 1 year following baseline – T4
study entry criteria
Inclusion Criteria

14 - 19 years old

12 - 28 weeks pregnant

Smokes one or more cigarettes/day

Read & understood English

Exclusion Criteria

Pregnancy complications

Confined to home for medical reasons

Study Entry Criteria

On average, pregnant female subjects (n = 142) were:

  • White (49%; 39%)
  • Single (32%)
  • 17 yrs. old (s.d. ± 1.3)
  • Gestation of 19 weeks (s.d. ± 7.2)
baseline tobacco use
Baseline Tobacco Use
  • Initiated smoking: 12 years (s.d. ± 2.3)
  • Regular smoker: 13 years (s.d. ± 2.1)
  • Cigarettes/day before pregnancy: 15 (s.d. ± 9.3)
  • Current Cigarettes/day: 7 (s.d. ± 4.6)
  • Nicotine Dependence (FTQ): 4 (s.d. ± 1.9)
  • Previous quit attempt: 78%
ethnic differences
Ethnic Differences

p < .001

p < .001

teen fresh start intervention
Teen Fresh Start - Intervention

Topics of group sessions

1-3: smoking patterns & effects on mom & baby

4: quit day

5: first steps of recovery

6: using coping skills

7: shared experience

8: celebrating healthy choices

group cotinine booster
Group, Cotinine, Booster

Cotinine level ng/ml

n = 38

predictors of abstinence
Predictors of Abstinence

Test of Model X2 = 12.9, 3df, p <.005

predictors of abstinence36
Predictors of Abstinence

Test of Model X2 = 11.9, 4df, p <.018

  • Short-term tobacco abstinence was effective with the TFS-Buddy intervention.
  • Neither the TFS or TFS-Buddy interventions were effective for long-term tobacco abstinence.
  • Tobacco abstinence during teenage pregnancy may be one event in which a teen’s peers and parents are in agreement.
  • Further research is needed to improve tobacco abstinence for pregnant adolescents and adults.
  • Teens with heavy dependence may benefit from nicotine replacement medications, but research is lacking in this area.
review questions developed by supercourse team

Review Questions(developed by Supercourse Team)

Why do you think at younger ages women now smoke more then men?

What are the predictors of relapse?