Review of Interventions
The report Expecting to Quit: A Best Practices Review of Smoking Cessation Interventions for Pregnant and Postpartum Girls and Women, 2nd edition examines interventions designed to reduce or eliminate smoking during pregnancy.
A total of ninety-seven studies were included in the review, of which seventy-one were randomized controlled trials, nineteen were controlled trials, and seven were cohort/quasi-experimental studies.
Eleven components of interventions and programs for pregnant smokers that commonly appeared in the effective interventions were identified. These components included:
- Quit Guides: Many interventions used some form of take-home, patient-focused guide to quitting, usually incorporating some skill building, tips on reduction and cessation, and advice.
- Counselling: Many interventions included some form of counselling, however brief, delivered by a range of practitioners from obstetricians to peers.
- Buddy/Peer Support: Many interventions encouraged the identification and involvement of a “buddy” for the pregnant woman as social support during the cessation process.
- Partner Counselling/Social Context: Some interventions included identification of the smoking patterns of the partner/father, friends, and family as key aspects of the assessment process.
- Information: Many interventions included some education about pregnancy and smoking in the form of pamphlets, videos, or other educational materials.
- Nicotine Replacement Therapies: Pharmacological components existed in some interventions to complement other approaches.
- Personal Follow-up: Several interventions incorporated personal follow-up with a view to sustaining the impact of the other components and offering encouragement, including postpartum.
- Other Follow-up: Other forms of follow-up were a distinct component, including paper-based communications to assess the effect of the intervention.
- Incentives: Both financial and symbolic rewards were incorporated into some interventions.
- Feedback about Biological Changes: Ultrasound images, stress tests, or other biological data were delivered back to the pregnant woman to illustrate the effects of smoking on the fetus.
- Groups: Some interventions included support groups or group counselling to deliver and/or sustain the intervention.
Based on evidence for their effectiveness and methodological strength, we recommended fourteen interventions, and classified twenty-seven as “showing promise.” Fifty-six interventions had weak evidence so they could not be recommended.
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