Quit for keeps: tailored smoking cessation guides for pregnancy and beyond

V. J Strecher
2000 Tobacco Control  
Although health care providers appear to be an obvious choice for delivering smoking cessation education, they often lack the resources, training, and time to provide anything more than a recommendation to quit and generic pamphlets for reinforcement. Traditionally, this type of material is designed to include information for many potential users, thus making it diYcult for an individual to find the pieces most relevant to them. In contrast, tailored print materials provide only information
more » ... h is relevant to a subject, making it far more usable. One study assessing tailored print messages found a threefold increase in cessation rates among patients in a family practice setting, four months after receipt of tailored versus untailored smoking cessation messages. 1 Numerous other studies, targeting a number of diVerent populations, have also shown that tailored messages are an eVective intervention for smoking cessation. 2 In tailoring, we use individual patient responses to select only relevant behaviour change messages. These messages provide information specific to an individual's needs and interests and can reinforce messages from health professionals. Because they are personalised, tailored materials oVer a potentially superior alternative to generic materials designed to reach a broad audience. Quit for Keeps used a pre-test/post-test experimental design to test the eVects of tailored interventions on pregnant smokers. Methods Participants in this study included 92 women enrolled at the Taubman obstetrics and gynaecology (ob/gyn) clinic at the University of Michigan and 81 women enrolled at the ob/gyn clinic at the University of North Carolina hospital from December 1996 to December 1997. Eligible participants were those who reported having smoked at least 100 cigarettes in their lifetime and who were either still smoking or had quit since becoming pregnant. Subjects were screened for eligibility during the New to the Nurse orientation program in North Carolina or during their first pre-natal visit to the clinic in Michigan. Potential subjects were given a hand held computer (Apple Newton MessagePad) and asked to fill out a short screening survey. After the computer determined that a subject was eligible, she was then approached by a research assistant and asked to participate in the project. Consenting women were then given the hand held computer for a second time and asked to complete the baseline questionnaire which assessed smoking status and asked questions on behavioural and psychosocial variables, including: stages of change for quitting smoking, perceived benefits of and barriers to quitting, self eYcacy, and demographic information. These constructs were used to create the tailored messages for those subjects randomised to the experimental condition. A urine sample was collected at baseline to confirm smoking status, and values < 80 ng/ml were considered indicative of abstinence. Subjects were then randomised via computer algorithm and assigned to either the control or experimental condition. Subjects in the experimental condition (n = 88) received a series of tailored smoking cessation messages through the mail, one after each pre-natal visit during which a follow up questionnaire was completed. Subjects in the control condition (n = 85) received A pregnant woman's guide to quit smoking after the first visit and no other materials. At each subsequent prenatal visit, women were again given the hand held computer and asked to complete a short follow up interview. The follow up interviews were used to assess a subject's progress toward quitting and any changes in barriers or benefits that could be addressed by the tailored messages. Urine samples were collected at the prenatal visit, during the 24th week of pregnancy, and again at the six week postpartum visit. Final data were collected, by telephone, at three months postpartum for evaluation purposes. Data were transferred from the hand held computers to a desktop computer. Data collected from subjects in the experimental condition were used to tailor a pregnancy guide and quit plan, which was mailed to their home. The guides included smoking cessation information, tips and strategies, and pictures and information about the developing fetus, tailored to the length of gestation. Each time a subject in the experimental group filled out a new interview during a prenatal visit, a new guide was sent with updated information. Results Baseline comparisons of women in the tailored and untailored materials conditions revealed no significant diVerences in age, race, education, number of cigarettes smoked before pregnancy, and baseline stage of change (table 1) . In order to examine the primary hypothesis of the study, we focused on postpartum, self reported cessation using an intent-to-treat model (treating women who were lost to follow up as smokers). In this model, 8 of the 87 (9.2%) women who received untailored Tobacco Control 2000;9(Suppl III):iii78-iii79 iii78 University of Michigan
doi:10.1136/tc.9.suppl_3.iii78 fatcat:o5ucjnq5dzhunla7pkzd64zlam