Elsevier

Addictive Behaviors

Volume 28, Issue 8, October 2003, Pages 1497-1505
Addictive Behaviors

Short Communication
Identification and recruitment of low-income pregnant smokers: Who are we missing?

https://doi.org/10.1016/S0306-4603(02)00269-1Get rights and content

Abstract

Extensive research has demonstrated the health consequences of smoking during pregnancy for both the mother and child. The majority of women, however, continue to smoke throughout the pregnancy and, of those who do quit, the majority return to smoking during the pregnancy or shortly after delivering the child. To best address this important public health problem, three critical goals must be accomplished: (1) development of effective interventions to help women quit smoking during pregnancy; (2) development of effective interventions to help women stay smoke-free during and after pregnancy; and (3) identification of effective methods of reaching women who smoke during pregnancy. Recruitment is the first window of opportunity to maximize our public health impact with pregnant women. Effective recruitment of women across all stages of change is needed, including both preaction stages and action stages. The current article examines the smoking habits of a large sample of low-income pregnant women. It compares those who enrolled in an intervention trial with those who did not enroll on a number of sociodemographic and individual characteristics, smoking patterns, and stage of change. The participants included 2280 pregnant women. Significant differences were found between enrollment groups on a number of variables, including stage of change [χ2(4)=54.74, P<.001], gestational age [t(955)=11.93, P<.001], and multiple smoking pattern variables (P<.001). In addition, a trend was found for ethnicity [χ2(5)=11.15, P<.05]. The findings of this study may help guide the development of enhanced recruitment strategies to expand our reach and thus our impact in this special population of smokers.

Introduction

Extensive research has demonstrated the health consequences of smoking during pregnancy for both the mother and child (USDHHS, 2001). Despite these well-known health consequences, the majority of women continue to smoke throughout the pregnancy and, of those who do quit, the majority return to smoking during the pregnancy or shortly after delivering the child (USDHHS, 2001). To best manage this important public health problem, three critical goals must be accomplished: (1) development of effective interventions to help women quit smoking during pregnancy; (2) development of effective interventions to help women stay smoke-free during and after pregnancy; and (3) identification of effective methods of reaching women who smoke during pregnancy. The focus of many researchers has been on developing and evaluating smoking cessation interventions. A number of these interventions have shown promise in helping pregnant women quit (USDHHS, 2000). Recent research has begun to examine interventions designed to help women remain smoke-free Ershoff et al., 1995, Mullen, 1999, Severson et al., 1997. As the field begins to identify effective interventions to help pregnant women become and remain smoke-free, it is important to begin to address the third goal needed to have the greatest impact on this public health problem. That is, smoking cessation interventions need to be widely delivered to all women who may benefit from them. Specifically, this goal involves identifying strategies to reach the greatest proportion of women who may benefit from these smoking cessation and maintenance interventions.

Recruitment is the first window of opportunity to maximize our public health impact with pregnant women. Our previous research has underscored the importance of using proactive recruitment approaches designed to include women across all of the stages of behavior change based on the transtheoretical model, not just those in the preparation stage (Ruggiero & deGroot, 1998) (see Table 1 for stage definitions). Effective recruitment of women across all stages of change is needed. The current article addresses the following questions in a large sample of low-income pregnant women: What are the characteristics of the population screened? Are there differences on sociodemographic and other individual characteristics across two groups, those who enrolled and those who did not enroll? And are there differences on smoking patterns and stage of change across these two groups? The information presented in this article may help guide the development of enhanced recruitment strategies to expand our reach and thus our impact in this special population of smokers.

Section snippets

Design

The data are from a randomized controlled trial examining the effects of a stage-based behavioral smoking cessation program compared with an enhanced standard care condition.

Recruitment of participants

Women were screened for eligibility and recruited for participation while waiting for routine prenatal appointments at a hospital public prenatal clinic. Eligibility criteria included: (a) age (>15 years old), (b) language (English as a primary language), (c) smoking status (if ever smoked), (d) gestational age (<34 weeks),

Results

Results of descriptive statistics are offered in Table 2, Table 3, Table 4. Chi-square and t-tests were conducted to examine differences across enrollment groups. As evident in Table 4, significant differences in proportions across groups were found for stage of change [χ2(4)=54.74, P<.001]. Examining the individual stages for differences in those enrolled versus those not enrolled indicates that 51% of those in the precontemplation stage, 68% of those in the contemplation stage, 72% of those

Discussion

The findings of the current study indicate that the majority of smokers in this population are in the contemplation (30%) and action (33%) stages. It is encouraging that most (68%) of the largest subgroup of current smokers (i.e., contemplators) enrolled in the intervention trial. Although more predictable, it is still notable that the majority (72%) of those in the preparation stage enrolled in the intervention trial. Perhaps most encouraging was the finding that about half of those in the

Acknowledgements

This study was funded by Grant CA71098 from the National Cancer Institute.

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