A Computer-Assisted Brief Motivational Intervention for Smoking During Pregnancy

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DESCRIPTION (provided by applicant): : BACKGROUND. Approximately 12% of pregnant women in the United States use tobacco products throughout pregnancy (Office of Applied Studies, 2004; U.S. Department of Health and Human Services, 2003). Smoking during pregnancy is associated with a wide range of negative effects, with strong evidence for increased risk of stillbirth, preterm birth, small size for gestational age, extended hospitalization of the infant, and SIDS (Cnattingius, 2004). Despite the clear efficacy of primary care-based behavioral interventions during the prenatal period, multiple obstacles?including limitations in time, reimbursement, willingness, and training?have prevented adequate adoption of such interventions. GOALS. This R21 exploratory/developmental Stage I and early Stage II study will develop simplified, computer-based versions of two efficacious intervention approaches in order to increase their feasibility, replicability, and reach. METHOD. This study will develop (a) a computer-based brief intervention for smoking during pregnancy, consisting of a single interactive session with the computer and computer-generated tailored mailings; and (b) a highly simplified and computer-assisted Contingency Management (CM) intervention (with reinforcement for cotinine-free urine being provided only at prenatal visits, and only for those who ask to provide a sample). Following iterative development based on expert and participant feedback, we will conduct a Phase I clinical trial designed to evaluate the feasibility and acceptability of the modified interventions, as well as to provide effect size estimates. African-American women (N = 160) who report smoking more than five cigarettes a day during pregnancy will be randomly assigned to computer-based brief intervention alone, CM alone, brief intervention plus CM, or attention control conditions with a 12-week lab-based follow-up. The primary outcome measure will be urinary cotinine-verified abstinence at follow-up; birth outcome data will also be collected. DISCUSSION AND PUBLIC HEALTH RELEVANCE. This study is the first step towards what could prove to be a highly cost-effective, replicable, practical, and prescriptive method for decreasing tobacco use among pregnant women. It is hoped that such a simplified, computer- based system will promote the widespread adoption of effective smoking cessation activities in prenatal clinics.