Moore Laurence, Campbell Rona, Whelan Amanda, Mills Nicola, Lupton Phillippa, Misselbrook Elizabeth, Frohlich Julie
Cardiff University School of Social Sciences, Cardiff CF10 3WT.
BMJ. 2002 Dec 14;325(7377):1383. doi: 10.1136/bmj.325.7377.1383.
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.
评估一种自助式孕期戒烟方法的有效性。
以社区助产士为随机分组单位的实用整群随机对照试验。
英格兰的三个国民保健服务医院信托机构。
1527名在孕期开始时吸烟的女性。
一系列五本自助手册，包含一个循序渐进的计划，以增强戒烟动力，并教授戒烟及预防复吸的策略。第一本手册由助产士在产前护理的最早时机交给女性，同时还会给伴侣、家庭成员和朋友一本手册。其余四本手册直接邮寄给女性。
主要结局是在妊娠中期结束时通过可替宁测量验证的戒烟情况。其他结局包括自我报告的吸烟状况和每日吸烟者的香烟消费量。还收集了探索干预措施可接受性以及两个试验组中戒烟建议提供方式的定性数据。
戒烟率较低：干预组可替宁验证的戒烟率为18.8%（113/600），常规护理组为20.7%（144/695）（差异为1.9%，95%置信区间为-3.5%至7.3%）。自我报告的戒烟率较高。在干预组中，156名（25.6%）女性报告至少七天不吸烟，而常规护理组为207名（29.1%）。在两组中，每日吸烟者自我报告的每日香烟消费量中位数均为每天10支。孕妇和助产士认可该干预措施，但实施方式差异很大。对于主要吸烟结局，助产士层面的聚集程度不可忽视（组内相关系数为0.031）。
自助干预措施是可接受的，但在常规产前护理期间实施时无效。需要制定和评估更强化、更复杂且针对性和适应性更强的干预措施。孕妇中经过验证的戒烟率远低于当前吸烟政策所依据的自我报告率。
