Objective: Reduction of tobacco smoke exposure during pregnancy is an important disease prevention goal for women and neonates. Individualizing tobacco control counseling to a pregnant woman’s life circumstances could reduce tobacco smoke exposure. The aims of study were to evaluate the effectiveness of the Smoke Free Families (SFF) program in reducing primary and second had smoke (ETS) exposure in pregnant families. Design: This study was a longitudinal randomized clinical trial with data being collected pre intervention, post intervention and at the end of pregnancy. Sample & Setting: A sample of 70 pregnant women who were managed care organization (MCO) subscribers had the following characteristics: mean age of 26, 81% were Caucasian, the mean number of cigarettes smoked at intake was 9, and income ranged from less that $15,000 to greater than $45,000 per year. Concepts & Intervention: The guiding concepts were based on Prochaska and DiClemente’s transtheoretical model. The hypotheses were that the treatment group women would show more progress than control group women in a) moving forward in the stages of change, b) reducing second hand smoke in their homes, and c) the contributions of self-efficacy, processes of change, and family support in predicting tobacco use stage of change were examined. Methods: Women were recruited from 7 MCO health centers in metropolitan Milwaukee, Wisconsin. The treatment group participated in SFF, a program consisting of two home visits in which the home and social environments were assessed, stage-matched tobacco control counseling occurred, and ETS control problem solving was done. The control group received usual prenatal care. Findings: The mixed effects ordinal regression analysis revealed that treatment group membership (p=.0002) and intake stage of change (p=.0000) were significant predictors of stage of change over time. None of the transtheoretical model variables were significant predictors of stage of change. ETS data were not normally distributed, so the values were ranked and a generalized estimating equation procedure was used. Groups were similar, with both reducing exposure over time (p=.04). Being older (p=.05) and living with other smokers (p=.002) were associated with higher ETS exposure. Conclusions: Although the intervention was effective in moving women forward in the stages of change of becoming a non-smoker, the transtheoretical model variables were not significant predictors. Although the trend was for all participants to decrease second had smoke exposure, the decrease could not be attributed to the intervention. Implications: Design issues associated with longitudinal studies will be discussed as potential confounders. The usefulness of the transtheoretical model for behavior change during pregnancy will be discussed. In addition, these findings are different from a study replication with low-income African American women in which there were no significant treatment effects. Potential explanations will be discussed.
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