Randomized trial of a "stage-of-change" oriented smoking cessation intervention in infertile and pregnant women
E G Hughes1, D A Lamont, M L Beecroft
1Departments of Obstetrics and Gynecology and Family Medicine, McMaster University, Hamilton, Ontario, Canada. hughese@fhs.csu.mcmaster.ca
Objective:
To assess a "stage-of-change" oriented smoking cessation intervention for infertile and pregnant women, compared with standard of care.
Design:
Randomized controlled trial.
Setting:
Three university teaching hospitals in Hamilton, Ontario, Canada.
Patient(S):
Infertile women at their first visit to a tertiary referral infertility clinic (n = 94) and new patients seeking pre-natal care (n = 110) who had smoked >/= 3 cigarettes in the past six months.
Intervention(S):
A three to five minute scripted intervention and booklet specific to the woman's "stage-of-change" in the smoking continuum, versus standard of care. Exhaled carbon-monoxide (CO) monitoring was used to validate exposure in both groups.
Main Outcome Measure(S):
Delta "stage-of-change" and rate of maintained cessation at 12 months post follow-up.
Result(S):
Intervention and control were similarly effective for infertile women: the rate of maintained cessation rose significantly from 4% to 24% over twelve months, with a mean delta "stage-of-change" 0.28. In prenatal women, neither approach was effective. Maintained cessation did not significantly change from 0 to 12 months (19% to 18%). Mean delta "stage-of-change" declined by -0.62.
Conclusion(S):
For infertile women, basic information describing the impact of smoking on fertility, along with exhaled CO monitoring and a more intensive intervention were both highly effective. In pregnant women neither approach was beneficial, with some evidence of post-partum relapse.
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