Hajek P, West R, Lee A, Foulds J, Owen L, Eiser J R, Main N
Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, UK.
Addiction. 2001 Mar;96(3):485-94. doi: 10.1046/j.1360-0443.2001.96348511.x.
To evaluate the efficacy of a brief smoking cessation intervention with pregnant women practicable routinely by midwives.
Midwives were randomized to deliver the experimental intervention or usual care. The 10-15-minute intervention was based on brief counselling, written materials, arrangements for continuing self-help support and feedback on expired-air carbon monoxide levels. The intervention was tailored to the women's needs: those who did not want to stop smoking received a brief motivational intervention, those who wanted to stop received an intervention designed to assist them and those that had stopped recently (recent ex-smokers) received a relapse prevention intervention.
Booking interviews with pregnant women in nine hospital and community trusts.
A total of 1120 pregnant women in the third month of pregnancy (249 recent ex-smokers and 871 current smokers).
Three indicators of biochemically validated abstinence were collected. Continuous abstinence for at least 3 months prior to delivery, point prevalence abstinence immediately post-delivery, and continuous abstinence from 3 months pre-delivery to 6 months post-delivery.
Only a small proportion of the women who would have been eligible to take part in the trial were actually recruited by 178 recruiting midwives, with lack of time being cited as the main barrier. The intervention and usual care groups differed in post-delivery point prevalence abstinence rates for recent ex-smokers (65% vs. 53%, p < 0.05, one-tailed), but not in other outcome measures. Overall, 54% of "recent ex-smokers" at booking and 7% of "current smokers" at booking had been abstinent for at least 3 months at the time of delivery, and 23% and 3%, respectively, were still abstinent by the time the child was 6 months old (i.e. 12 months post-intervention). Smoking status at follow-up was predicted by dependence indexed by time to first cigarette in the morning.
A brief "one-off" smoking cessation intervention by midwives does not seem to be a practicable or effective method of helping pregnant smokers to stop. Other options such as tailored self-help materials and telephone counselling and other specialist treatments should be examined. Current smoking cessation rates in pregnancy are very low.
评估由助产士常规实施的针对孕妇的简短戒烟干预措施的效果。
将助产士随机分为两组，分别实施实验性干预措施或常规护理。这项为期10 - 15分钟的干预措施基于简短咨询、书面材料、持续自助支持安排以及对呼出气体一氧化碳水平的反馈。干预措施根据女性的需求进行调整：那些不想戒烟的女性接受简短的动机干预，那些想戒烟的女性接受旨在帮助她们的干预，而那些最近已经戒烟的女性（近期戒烟者）接受预防复吸干预。
在九个医院和社区信托机构对孕妇进行预约访谈。
总共1120名怀孕三个月的孕妇（249名近期戒烟者和871名当前吸烟者）。
收集了三个经生化验证的戒烟指标。分娩前至少连续戒烟3个月、分娩后即刻的时点戒烟率以及从分娩前3个月到产后6个月的连续戒烟情况。
在178名参与招募的助产士中，实际招募到的符合参与试验条件的女性比例很小，时间不足被认为是主要障碍。干预组和常规护理组在近期戒烟者的产后时点戒烟率方面存在差异（65%对53%，p < 0.05，单尾），但在其他观察指标上没有差异。总体而言，预约时54%的“近期戒烟者”和7%的“当前吸烟者”在分娩时已连续戒烟至少3个月，到孩子6个月大时（即干预后12个月），仍分别有23%和3%的人保持戒烟状态。随访时的吸烟状况由早晨第一支烟的时间所反映的烟瘾程度来预测。
助产士进行的简短“一次性”戒烟干预似乎不是帮助怀孕吸烟者戒烟的可行或有效方法。应研究其他选择，如量身定制的自助材料、电话咨询和其他专业治疗方法。目前孕期的戒烟率非常低。
