Effectiveness of a Combined Prenatal and Postpartum Smoking Cessation Program
Effectiveness of a Combined Prenatal and Postpartum Smoking Cessation Program
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DOI：
10.1007/s10995-010-0568-9
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发表时间：
2011-02-01
影响因子：
2.3
通讯作者：
Jenkins, Paul
中科院分区：
文献类型：
--
作者：
Gadomski, Anne;Adams, Laurie;Jenkins, Paul
妇女经常在怀孕期间戒烟，但在产后又复发。婴儿和我-无烟计划结合了产前和产后戒烟咨询和生物标志物反馈与每月产后奖励。这些设置包括纽约州北部的22个地点（WIC办公室和产前诊所）。采用准实验设计来评估这种干预，包括四次面对面的产前咨询，咨询师提供戒烟咨询，一氧化碳测试和随机唾液可替宁测试。产后1年，母亲们每3-4周进行一次生化测试，如果阴性，则发放尿布代金券。研究了三种实施模式：固定地点的多任务辅导员（模型1和2）与巡回戒烟专家（模型3）。结果包括怀孕期间和产后经生化验证的禁欲率。采用Logistic回归确定产后戒断和计划退出的预测因素。采用比例风险回归比较实施模型。在参加该项目的777名孕妇中，有588名符合产后项目的条件。妊娠意向治疗戒烟率为60%。产后，模型3的戒烟效果始终优于其他模型。产后6个月禁欲的预测因子为：年龄较大（OR = 1.07, 95% C.I. 1.02-1.12），较低的基线一氧化碳水平（OR = 0.69, 95% C.I. 0.49-0.97），模型3 （OR = 4.60, 95% C.I. 2.80-7.57）和参加更多的产前检查（OR = 3.52, 95% C.I. 2.19-5.65）。婴儿和我无烟计划是一个有效的戒烟计划，为孕妇和育儿妇女。
Women frequently quit smoking during pregnancy but then relapse postpartum. The BABY & ME-Tobacco Free program combines prenatal and postpartum smoking cessation counseling and biomarker feedback with monthly postpartum incentives. The settings included 22 sites (WIC offices and prenatal clinics) in upstate New York. A quasi-experimental design was used to evaluate this intervention, that included four face-to-face prenatal sessions with a counselor who did smoking cessation counseling, carbon monoxide testing and random saliva cotinine testing. For 1 year postpartum, mothers were biochemically tested every 3-4 weeks and, if negative, were issued a voucher for diapers. Three implementation models were studied: multi-tasking counselors at fixed sites (Models 1 and 2) versus itinerant smoking cessation specialists (Model 3). Outcomes included biochemically validated abstinence rates during pregnancy and postpartum. Logistic regression was used to identify predictors of postpartum abstinence and program dropout. Proportional hazards regression was used to compare implementation models. Of the 777 pregnant women who enrolled in the program, 588 were eligible for the postpartum program. The intention to treat pregnancy quit rate was 60%. Postpartum, Model 3 showed consistently better quit outcomes than the other models. Predictors of abstinence at 6 months postpartum are: older age (OR = 1.07, 95% C.I. 1.02-1.12), lower baseline carbon monoxide level (OR = 0.69, 95% C.I. 0.49-0.97), Model 3 (OR = 4.60, 95% C.I. 2.80-7.57) and attending more prenatal sessions (OR = 3.52; 95% C.I. 2.19-5.65). The BABY & ME-Tobacco Free program is an effective smoking cessation program for pregnant and parenting women.