Saturday, July 14, 2007
This presentation is part of : EBN Strategy for Pregnant Patients
A Mental Health Intervention to Help Pregnant Smokers Quit
Ann R. Peden, ARNP-CS, DSN, Mary Kay Rayens, PhD, Lynne A. Hall, RN, DrPH, Ellen J. Hahn, RN, DNS, Carol A. Riker, RN, MSN, Kristin Ashford, ARNP, MSN, and Mei Zhang, MSN, MPH, RN. College of Nursing, University of Kentucky, Lexington, KY, USA
Learning Objective #1: examine the effects of depressive symptoms on smoking cessation.
Learning Objective #2: describe a cognitive-behavioral group intervention designed to assist with smoking cessation in pregnancy.

Background: Although motivation to quit smoking during pregnancy is high, only one-third of pregnant women who stop smoking during pregnancy remain smoke-free one year after delivery. Depression has been identified as a significant predictor of smoking during pregnancy; depressed women are less confident about quitting than non-depressed women. 

 Purpose:  To test the effects of a cognitive-behavioral group and telephone intervention during and after pregnancy on women’s self-reported smoking and quit rates, nicotine dependence, urine cotinine, and mental health measures.

 Methods:  A quasi-experimental, two-group repeated measures design was used.  Data were collected at baseline, one month after the group intervention and two and four months postpartum. The treatment group (n = 11) received the intervention during and immediately after pregnancy. The control group (n = 5) only responded to in-person interviews. Mental health measures included two depressive symptoms scales (CES-D and BDI), negative thinking (CCI), and chronic stressors (ESI). Data were summarized using descriptive statistics and group comparisons were made using two-sample t-tests or chi-square tests.

 Results:  While the two treatment groups were similar on all demographics and outcome variables at baseline, the intervention group had fewer depressive symptoms (for both CES-D and BDI) and thoughts of hopelessness (a subscale of the CCI) than the controls at the first post-intervention interview. Cigarette use, nicotine dependence, and urine cotinine did not change significantly from baseline to the first post-intervention interview. Subject attrition postpartum precluded quantitative analysis of data collected at the third and fourth interview.

 Conclusion: This exploratory study supports the effectiveness of a mental health intervention in decreasing depressive symptoms and hopelessness among pregnant smokers. A larger trial is needed to demonstrate the effectiveness of this integrated mental health intervention in promoting quit attempts and smoking abstinence in these at-risk women.