Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women

Abstract

This study evaluated a theory-guided cognitive-behavioral counseling (CBC) intervention for smoking cessation during pregnancy and postpartum. It also explored the mediating role of cognitive-affective variables on the impact of CBC. Underserved inner city pregnant women (N = 277) were randomized to the CBC or a best practice (BP) condition, each of which consisted of two prenatal and two postpartum sessions. Assessments were obtained at baseline, late pregnancy, and 1- and 5-months postpartum. An intent-to-treat analysis found no differences between the two groups in 7-day point-prevalence abstinence. However, a respondents-only analysis revealed a significantly higher cessation rate in the CBC (37.3 %) versus the BP (19.0 %) condition at 5-months postpartum follow-up. This effect was mediated by higher quitting self-efficacy and lower cons of quitting. CBC, based on the Cognitive-Social Health Information Processing model, has the potential to increase postpartum smoking abstinence by assessing and addressing cognitive-affective barriers among women who adhere to the intervention.

Keywords: Cognitive behavioral intervention; Postpartum; Psychosocial mediators; Smoking cessation; Underserved pregnant women.

Fig. 1

Flowchart of recruitment and attendance at counseling sessions and follow-up assessments

Fig. 2

Mediation pathway of treatment condition on smoking cessation at 5-month postpartum assessment with change of cons of quitting as the mediator. Note: a is an unstandardized regression coefficient, and b, c, and c′ are unstandardized logistic regression coefficients. *p < .05; **p <.01; ***p < .001