Richard A. Windsor

The effectiveness of smoking cessation methods for smokers in public health maternity clinics: a randomized trial.

Little insight is available in the literature on how best to assist the pregnant smoker in public health maternity clinics to quit during pregnancy. A randomized pretest/posttest experiment was used to evaluate the effectiveness of two different self-help cessation methods. Three hundred and nine pregnant women from three public health maternity clinics were assigned randomly to one of three groups with one-third assigned to each: a control group; a group receiving the American Lung Associations Freedom From Smoking Manual; and those receiving A Pregnant Womans Self-Help Guide to Quit Smoking. Using a saliva thiocyanate (SCN) and behavioral report at mid-pregnancy and end of pregnancy to confirm cessation or reduction, 2 per cent in the control group quit and 7 per cent reduced their SCN levels substantially. Of the women assigned to the ALA method, 6 per cent quit and 14 per cent reduced their SCN levels substantially. Of the women who used the Guide, 14 per cent quit and 17 per cent reduced their SCN levels substantially. Results of this trial indicate that health education methods tailored to the pregnant smoker are more effective in changing smoking behavior than the standard clinic information and advice to quit and/or the use of smoking cessation methods not tailored to the needs of the pregnant smoker.

Health education for pregnant smokers : its behavioral impact and cost benefit

OBJECTIVES A randomized trial (the Birmingham Trial II) was conducted to evaluate the behavioral impact of health education methods among 814 female smokers at four public health maternity clinics. METHODS Four hundred patients were randomly assigned to an Experimental (E) Group, and 414 were assigned to a Control (C) Group. Self-reports and saliva cotinine tests confirmed smoking status at the first visit, at midpregnancy, and at end of pregnancy. RESULTS The E Group exhibited a 14.3% quit rate and the C Group an 8.5% quit rate. A Historical Comparison (C) Group exhibited a 3.0% quit rate. Black E and C Group patients had higher quit rates than White E and C Group patients. A cost-benefit analysis found cost-to-benefit ratios of

Quality of Measurement of Smoking Status by Self-Report and Saliva Cotinine Among Pregnant Women

1:

The process of pregnancy smoking cessation: Implications for interventions

6.72 (low estimate) and

Condom Availability Programs in Massachusetts High Schools: Relationships With Condom Use and Sexual Behavior

1:

Recommended cessation counselling for pregnant women who smoke: a review of the evidence

17.18 (high estimate) and an estimated savings of

Effectiveness of Agency for Health Care Policy and Research clinical practice guideline and patient education methods for pregnant smokers in Medicaid maternity care

247,296 (low estimate) and

The discrepancy between self-reported smoking status and urine continine levels among women enrolled in prenatal care at four publicly funded clinical sites.

699,240 (high estimate). CONCLUSION Health education methods are efficacious and cost beneficial for pregnant smokers in public health maternity clinics.

ASSESSING ADHERENCE TO ASTHMA MEDICATION AND INHALER REGIMENS : A PSYCHOMETRIC ANALYSIS OF ADULT SELF-REPORT SCALES

Objective. The objectives of this paper were to determine the rate of misclassification of smoking and nonsmoking status by self-reports and saliva cotinine of pregnant women participating in a smoking cessation trial, determine the relationship of the number of cigarettes smoked per day and saliva cotinine, and examine whether misclassification was due to an inappropriate saliva cotinine cutoff point. Methods. End of pregnancy self-reports of smoking status and saliva cotinine were used to calculate misclassification rates. Results. The findings revealed that 61 of 441 self-reported smokers had biochemical values inconsistent with smoking status for a smoking misclassification rate of 13.8%. The results also revealed that 28 of 107 self-reported quitters had cotinine values consistent with smoking status for a nonsmoking misclassification rate of 26.2%. Receiver Operating Characteristic (ROC) curves were then plotted to determine whether misclassification resulted from an inappropriate cutoff point. The cotinine cutoff point that maximized sensitivity and specificity for all women was 24 ng/ml. Racial ROC comparisons indicated a higher cutoff point for blacks than whites. Use of any of the ROC indicated cutoff points would not change the misclassification rates. Conclusions. These findings suggest that underreporting of smoking status during pregnancy is high and that social desirability of nonsmoking status may have contributed to the lack of precision in saliva cotinine to distinguish smoking status in this study.

Evaluation of the efficacy and cost effectiveness of health education methods to increase medication adherence among adults with asthma.

OBJECTIVE There is a growing body of knowledge about the pregnant smoker and what happens as she goes through the pregnancy and postpartum periods. This article reviews the process of smoking cessation in the context of pregnancy. DATA SOURCES Epidemiological data, extant reviews of the literature, and current original research reports are used to examine characteristics of the women and of the change process for those women smokers who quit, stop, or modify their smoking during pregnancy and the postpartum period. DATA SYNTHESIS An analysis of the interaction of the process of smoking cessation with pregnancy was conducted to gain insight into the unique problems faced by the pregnant smoker and discover directions for intervention. CONCLUSIONS Pregnancy and the postpartum period provide a window of opportunity to promote smoking cessation and smoke free families. Understanding obstacles and pathways for pregnancy and postpartum smoking cessation can guide implementation of effective existing programs and development of new ones. Recommendations include promoting cessation before and at the beginning of pregnancy, increasing delivery of treatment early in pregnancy, helping spontaneous and intervention assisted quitters to remain tobacco free postpartum, aiding late pregnancy smokers, and involving the partner of the woman smoker.