Prenatal and postpartum smoking abstinence a partner-assisted approach. Effects of a health education programme with telephone follow-up during cardiac rehabilitation. Self help smoking cessation in pregnancy: cluster randomised controlled trial. Preliminary investigation of a culturally specific smoking cessation intervention for Hispanic smokers. Smoking as a vital sign: prompts to ask and assess increase cessation counseling. Partner support, psychological treatment, and nicotine gum in smoking treatment: an incremental study. Brief supportive telephone outreach as a recruitment and intervention strategy for smoking cessation. Smoking cessation in primary care clinics. Co-worker social support in a worksite smoking control program. Helping smokers to decide on the use of efficacious smoking cessation methods: a randomized controlled trial of a decision aid.
A partner's provision of support and smoking status has been consistently associated with women's likelihood of smoking cessation during pregnancy and relapse in postpartum.
                A three-group randomized controlled intervention trial was conducted in 1996 to 2001, with 583 women and their partners randomized to usual care (UC), woman-only (WO), or partner-assisted (PA) intervention. Follow-ups occurred at 28 weeks of pregnancy, and 2-, 6-, and 12-months postpartum.
                Womack Army Medical Center (WAMC) at Fort Bragg in Fayetteville, North Carolina.
                Women in the UC condition received provider advice to quit and a self-help guide. The WO condition received UC components plus a late-pregnancy relapse prevention kit (booklet and gift items) and six counseling calls (three in pregnancy and three postpartum) initiated by a health advisor. Women in the PA condition received the WO intervention, and their partners received telephone counseling and a support guide emphasizing skills to help the woman build and maintain her confidence to quit smoking. Partners who smoked also received cessation aids and related counseling.
                Seven-day self-reported abstinence from smoking at each follow-up.
                Intent-to-treat analyses showed no significant differences by condition in women's reports of abstinence at any follow-up. In late pregnancy, more partners were abstinent in the PA condition (15%) than in the UC condition (5%), p =0.02.
                Partner-assisted smoking-cessation interventions need further refinement. Influencing young couples' support patterns may require more intensive and conjoint intervention. Partners who smoke could benefit from support for their cessation efforts. A health education and counselling programme was offered to myocardial infarction patients during and after hospitalization. A randomized pre-test-post-test control group design was used to evaluate the effects of the experimental intervention. During hospitalization the intervention consisted of two individual counselling sessions and two group health education sessions focusing on medication, healthy habits, anxiety and depression. On completion of these sessions, weekly telephone calls were made to patients for a period of six weeks after discharge from hospital. The intervention was offered to 30 myocardial infarction patients and their partners (the experimental group) in addition to standard medical care. Thirty control patients received standard medical care only. Two months after myocardial infarction, patients in the experimental condition reported a significantly greater increase in physical activity, and a significantly greater decrease in unhealthy eating habits. No effects were found regarding smoking cessation, anxiety and depression. Twelve months after discharge from hospital patients in the experimental condition reported a significantly greater decrease in unhealthy eating habits. No effects were found regarding smoking cessation, physical activity, anxiety and depression. In addition, two months after myocardial infarction, it was found that patients whose partners participated in the health education sessions showed a significantly greater decrease in smoking and unhealthy eating habits and a significantly greater increase in physical activity than patients with no partner participating. Twelve months after discharge the only significant result favouring the patients whose partner participated in the health education sessions concerned smoking cessation. To evaluate the effectiveness of a self help approach to smoking cessation in pregnancy.
                Pragmatic cluster randomised controlled trial with community midwife as the unit of randomisation.
                Three NHS hospital trusts in England.
                1527 women who smoked at the start of pregnancy.
                A series of five self help booklets comprising a step by step programme to increase motivation for quitting smoking and to teach strategies for cessation and relapse prevention. The first booklet was given to the women by a midwife at the earliest opportunity in antenatal care, together with a booklet for partners, family members, and friends. The remaining four booklets were mailed directly to the women.
                The primary outcome was smoking cessation validated by cotinine measurement at the end of the second trimester of pregnancy. Other outcomes were self reported smoking status and cigarette consumption among daily smokers. Qualitative data exploring the acceptability of the intervention and the way that smoking cessation advice was delivered in both trial arms were also collected.
                Smoking cessation rates were low: the cotinine validated rates were 18.8% (113/600) in the intervention group and 20.7% (144/695) in the normal care group (difference 1.9%, 95% confidence intervals -3.5% to 7.3%). Self reported quit rates were higher. In the intervention group, 156 (25.6%) women reported not smoking for at least seven days, compared with 207 (29.1%) in the normal care group. In both groups, median self reported daily cigarette consumption among daily smokers was 10 cigarettes per day. Pregnant women and midwives approved of the intervention, but the way in which it was delivered varied considerably. For the primary smoking outcome, the degree of clustering at the midwife level was non-trivial (intracluster correlation coefficient 0.031).
                The self help intervention was acceptable but ineffective when implemented during routine antenatal care. More intensive and complex interventions, appropriately targeted and tailored, need to be developed and evaluated. Validated smoking cessation rates among pregnant women are substantially lower than the self reported rates on which current smoking policy is based. The purpose of this study was to compare a culturally specific, multicomponent behavioral smoking cessation program for Hispanic smokers with a low-intensity, enhanced self-help control condition.
                Participants who completed pretreatment assessment were randomly assigned to treatment conditions. Smoking status was evaluated at posttreatment, 6-month follow-up, and 12-month follow-up intervals.
                The study was based in predominantly Hispanic neighborhoods in Queens, New York.
                Ninety-three Hispanic smokers participated: 48 men and 45 women.
                The multicomponent treatment involved a clinic-based group program that incorporated a culturally specific component consisting of videotaped presentations of culturally laden smoking-related vignettes. The self-help control program was enhanced by the use of an introductory group session and follow-up supportive telephone calls.
                Smoking outcomes were based on cotinine-validated abstinence and self-reported smoking rates. Predictors of abstinence were examined, including sociodemographic variables, smoking history, nicotine dependence, acculturation, partner interactions, reasons for quitting, self-efficacy, and linguistic competence.
                Significant group differences in cotinine-validated abstinence rates in favor of the multicomponent group were obtained, but only at posttreatment. With missing data included and coded for nonabstinence, validated abstinence rates at posttreatment were 21% for the multicomponent group and 6% for the self-help group. At the 6-month follow-up, the rates were 13% for the multicomponent group and 9% for the self-help group. By the 12-month follow-up, the rates declined to 8% and 7% for the multicomponent and self-help groups, respectively. A dose-response relationship between attendance at group sessions and abstinence status was shown at posttreatment and 6-month follow-up intervals.
                The results of the present study failed to show any long-term benefit from use of a clinic-based, culturally specific multicomponent smoking cessation intervention for Hispanic smokers relative to a minimal-contact, enhanced self-help control. Strategies to improve smoking cessation counseling in clinical settings are critical to supporting smokers' attempts to quit. This study evaluates the impact of adding 2 smoking-related vital sign questions in an electronic medical records system on identification, assessment, and counseling for patients who smoke: "Current smoker?" and "Plan to quit?"
                Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics.
                From before to after intervention, identification of smokers increased 18% (from 71% to 84%; P<.001), and assessment for a plan to quit increased 100% (from 25.5% to 51%; P<.005). Among all smokers, cessation counseling increased 26% (from 23.6% to 29.8%; P=.41). Significantly more smokers who received the assessment for a plan to quit received cessation counseling (46% vs. 14%, P<.001). Regression analysis showed that patients receiving an assessment for plan to quit were 80% more likely to receive cessation counseling (OR 0.209; 95% CI, 0.095-0.456).
                Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit. Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling. Smokers (N = 99) were randomly assigned to one of three conditions: nicotine gum (NG), nicotine gum plus psychological treatment (NG-PT), and nicotine gum plus psychological treatment and partner support (NG-PT-PS). Data were collected at Weeks 0, 4, 12, 26, and 52 from study start. Contrary to expectations, NG-PT-PS and NG-PT failed to increase abstinence rates. Subjects who were closer to their support partners had significantly lower abstinence rates with NG-PT-PS than with the other conditions, although not significantly at Weeks 26 and 52. Treatments without partner participation (NG-PT and NG) were significantly more effective for subjects who had an extremely close support partner outside the treatment setting than for those who did not at all weeks. The role of social support in smoking treatment is discussed. Formal efforts to recruit smokers into cessation programs have failed to reach large segments of the smoking population. Telephone intervention may represent a viable strategy to promote smoking cessation. An even more promising approach may be a combination of brief telephone support and outreach to identified smokers.
                Telephone support for smoking cessation was provided to four identified smoker populations in Bloomington, Minn, one of three Minnesota Heart Health Program education communities. Smokers were randomly assigned to an intervention consisting of two 15-minute telephone calls approximately 1 to 3 weeks apart or to a nonintervention control.
                At the 6-month follow-up, a significant overall effect was found in favor of the intervention condition for both self-reported and cotinine-validated quitting. Differences between intervention and control conditions were no longer significant at 18 months.
                Smokers' receptivity to telephone intervention was at least moderately encouraging. The cost of intervention could be relatively low if trained volunteers initiated telephone calls. However, more intensive telephone intervention and support may be needed to produce lasting changes in smoking prevalence. To document smoking cessation rates achieved by applying the 1996 Agency for Health Care Policy and Research (AHCPR) smoking cessation guidelines for primary care clinics, compare these quit rates with historical results, and determine if quit rates improve with an additional motivational intervention that includes education as well as spirometry and carbon monoxide measurements.
                Randomized clinical trial.
                Two university-affiliated community primary care clinics.
                Two hundred five smokers with routinely scheduled appointments.
                All smokers were given advice and support according to AHCPR guidelines. Half of the subjects received additional education with spirometry and carbon monoxide measurements.
                Quit rate was evaluated at 9-month follow-up. Eleven percent of smokers were sustained quitters at follow-up. Sustained quit rate was no different for intervention and control groups (9% vs 14%; [OR] 0.6; 95% [CI] 0.2, 1.4). Nicotine replacement therapy was strongly associated with sustained cessation (OR 6.7; 95% CI 2.3, 19.6). Subjects without insurance were the least likely to use nicotine replacement therapy ( p =.05). Historical data from previously published studies showed that 2% of smokers quit following physician advice, and additional support similar to AHCPR guidelines increased the quit rate to 5%.
                The sustained smoking cessation rate achieved by following AHCPR guidelines was 11% at 9 months, which compares favorably with historical results. Additional education with spirometry did not improve the quit rate. Nicotine replacement therapy was the strongest predictor of cessation, yet was used infrequently owing to cost. These findings support the use of AHCPR guidelines in primary care clinics, but do not support routine spirometry for motivating patients similar to those studied here. We evaluated the effects of adding a social support component to a worksite controlled smoking treatment program. Twenty-four participants were randomly assigned to either a controlled smoking or a controlled smoking plus partner support condition. Within a multiple baseline across behaviors design, smokers in both conditions made efforts to achieve sequential 50% reductions in: nicotine content of brand smoked, number of cigarettes smoked per day, and percentage of each cigarette smoked. Self-monitoring records, laboratory analyses of spent cigarette butts, and carbon monoxide determinations indicated that both conditions were effective in producing significant reductions in each of the three target behaviors and in carbon monoxide levels. All participants who quit smoking during the program maintained their abstinence at a 6-month follow-up, and those who did not quit were smoking less at follow-up than they had at pretest on all dependent variables. However, few differences were observed between controlled smoking and controlled smoking plus partner support conditions either during treatment or at the 6-month follow-up. Results are discussed with regard to previous worksite studies, future directions for research on social support, and variables that may have mediated treatment outcome. Most smokers attempt to stop smoking without using help. We evaluated the efficacy of a decision aid to motivate quitters to use efficacious treatment. SETTING AND PARTICIPANTS, A total of 1,014 were recruited from a convenience sample of 3,391 smokers who intended to quit smoking within 6 months. DESIGN AND Smokers were assigned randomly to either receive the decision aid or no intervention. The decision aid was expected to motivate quitters to use efficacious cessation methods and contained neutral information on treatment methods, distinguishing between efficacious and non-efficacious treatments. MEASUREMENTS Baseline questionnaire and follow-ups were used 2 weeks and 6 months after the start of the intervention.
                The decision aid increased knowledge of cessation methods and induced a more positive attitude towards these methods. Furthermore, 45% reported increased confidence about being able to quit and 43% said it helped them to choose between treatments. However, no clear effect on usage of treatment aids was found, but the intervention group had more quit attempts (OR=1.52, 95% CI 1.14-2.02) and higher point prevalence abstinence at 6-month follow-up (20.2% versus 13.6%; OR=1.51, 95% CI=1.07-2.11). CONCLUSIONS An aid to help smokers decide to use efficacious treatment when attempting to quit smoking had a positive effect on smoking cessation, while failing to increase the usage of efficacious treatment. This finding lends support to the notion that the mere promotion of efficacious treatments for tobacco addiction might increase the number of quit attempts, irrespective of the actual usage of treatment.
In this review of randomized controlled trials of interventions designed to enhance partner support for smokers in cessation programmes, we failed to detect an increase in quit rates. Limited data from several of the trials suggest that these interventions also did not increase partner support. No conclusions can be made about the impact of partner support on smoking cessation. Additional studies with larger samples are needed to adequately explore the effects of partner support interventions for smoking cessation.