An Investigation of Contingency Management for Pregnant Smokers in Appalachia

Cigarette smoking during pregnancy is associated with premature birth and low birth weight. The US Surgeon General reported that eliminating smoking during pregnancy could prevent 10% of all infant deaths. Additionally, these negative effects of smoking occur during the later stages of pregnancy rather than early stages. If pregnant smokers quit smoking by in the first fifteen weeks of pregnancy, both gestational age and birth weight are comparable to infants of nonsmokers. For these reasons, establishing accessible and effective smoking cessation treatment for women who are pregnant, especially if cessation is achieved within the first trimester, would represent a significant advancement in improving infant health for this population. The purpose of this protocol is to test the efficacy of an Internet based abstinence reinforcement intervention for promoting smoking cessation in pregnant women in Appalachian communities. This intervention will be combined with a standard treatment (the 5 A's) delivered by a trained phone educator. We will compare the efficacy of the combined interventions with the 5 A's alone (control) and a no study intervention condition (i.e., an observation only group; community control). Because of the relatively limited availability of smoking cessation programs in Eastern Kentucky, this pilot project will target pregnant Appalachian smokers. We hypothesize that the combined treatment group will experience greater reductions in smoking and better birth outcomes than either of the control groups. This protocol will be conducted in parallel with a project being conducted through the Nationwide Children's Hospital in Columbus, OH.