Postnatal smoking relapse, its associated risk factors, and a proactive sustainable preventive intervention

PRISM

Improving maternal and child health is a key public health issue, a concern for the health policy makers, and one of particular relevance in developing countries. Maternal smoking is one of the most modifiable factors clearly linked to adverse effects for the fetus and the baby. While smoking during pregnancy is still common in some populations, including Central and Eastern Europe (CEE), many smokers quit upon finding out about the pregnancy. A significant problem, and the focus of this project, is that the majority of the women who quit as they found out about the pregnancy, or during the pregnancy, resume smoking after birth.

The rationale for this project is that its successful completion will improve the understanding of postpartum smoking relapse, and will establish the effectiveness of an innovative prevention program. The extent of the postpartum smoking relapse and its associated risk factors are well-established in developed-country populations, but there is a lack of such research in developing countries and across diverse populations and health systems. Our project will fill this research gap. And because one of the most important factor that negatively influence the outcome of such interventions is the lack of support from husbands or partners, the project aims to motivate them to support women in their quest to remain non-smokers.

Objectives of the study

(1) To design, pretest, and refine an innovative intervention preventing smoking relapse after pregnancy to maximize feasibility and potential impact;

(2) To implement and evaluate an intervention to prevent maternal smoking relapse after pregnancy in a randomized controlled trial setting;

(3) To assess the extent of postpartum smoking relapse and associated risk factors among women who spontaneously quit smoking during pregnancy.

Study design

This three-year longitudinal study will enroll a total of 425 women who spontaneously quit smoking during pregnancy and randomly assign them to an intervention (n=125), a control (n=125) or an additional sample (n=175) group. The recruitment will take place during the delivery hospital stay in one of the largest obstetrics-gynecology hospitals in Cluj-Napoca, Romania.

Mothers in the intervention group will participate in three motivational interviewing sessions (one week, one month, and three months after enrollment) over the phone. Their partners will also be contacted within 1-3 weeks after the women are enrolled in the study and invited to participate in a motivational interview session over the phone. All women (n=425) and their partners will be contacted for a 6-month follow-up when their smoking status will be assessed.

Starting / Ending Date

Project Coordinator

Funding

Staff from Department of Public Health

Associated Researcher

Assistant Professor

Project Outputs

Scientific Reports

2013

In the first year of the project, the study team contacted the clinic included in the study, developed and calibrated the study data collection instruments and materials used for the PRISM intervention, developed the methodology and standard operating procedures for data collection and intervention delivery (the Standard Operating Procedure Manual, the Eligibility Registry, the Subject’s file, and the Counselor Registry), developed an analytical plan to analyze the pre-intervention data, and recruited and trained two data collectors and two counselors to deliver the PRISM intervention. In addition, the project team initiated the data collection process and the delivery of the PRISM intervention. All contract objectives of the project for 2013 were met. A summary report in Romanian can be found here: Download here.

2014

In the second year of the project, the study team continued the data collection process and the delivery of the PRISM intervention, initiated the evaluation of the intervention, and started to collect the necessary data to evaluate the prevalence of smoking relapse in the postpartum period among women who spontaneously quit smoking upon finding out about their pregnancy. In the year 2014, the dissemination of the project was conducted by maintaining and updating the project’s website and by submitting and article for publication to a scientific, ISI journal. All contract objectives of the project for 2014 were met. A summary report in Romanian can be found here. Download here.

2015

In the third year of the project, the study team continued the enrollment of subjects in the randomized controlled trial, the data collection process to assess the effectiveness of the PRISM intervention, and the data collection process to evaluate the prevalence of smoking relapse in the postpartum period. In 2015, the dissemination of the project was conducted by publishing a scientific manuscript in an ISI journal, by submitting a manuscript for publication to a scientific, ISI journal, by maintaining and updating the project’s website and by participating in an international conference with two oral presentations. All contract objectives of the project for 2015 were met. A summary report in Romanian can be found here. Download here.

2016

In 2016, the last year of the project, the research has finalized the enrollment of subjects in the randomized controlled trial, the data collection process evaluating the effect of the PRISM intervention, as well as the data collection process focusing on evaluating the prevalence of smoking relapse in the postpartum period. In 2016, the project and its results was disseminated by submitting two scientific manuscripts for publication in an ISI journal, by writing and disseminating two press releases related to project’s activities, by participating in two scientific conferences with two oral and two poster presentations, and by updating the project’s website. All contract objectives of the project for 2016 were met. A summary of the report in Romanian for the period 2013-2016 can be found here. Download here.

Scientific Publications

Meghea, C. I., Brînzaniuc, A., Mihu, D., Iuhas, C. I., Stamatian, F., Caracostea, G., … & Cherecheș, R. M. (2015). A couple-focused intervention to prevent postnatal smoking relapse: PRISM study design. Contemporary clinical trials, 41, 273-279. DOI: dx.doi.org/10.1016/j.cct.2015.02.002

 

Scientific Conferences

Conference 1

Conference: 1st International Conference on Non-Communicable Diseases (19-20 May 2015)
Presentation Title: Smoking Cessation During and Around Pregnancy: Past, Present, and Future Research in Romania
Speaker: Cristian I. Meghea
Type: Oral presentation

Conference 2

Conference: 1st International Conference on Non-Communicable Diseases (19-20 May 2015)
Presentation Title: Using Motivational Interviewing to Support Smoking Cessation and Prevent Smoking Relapse During Pregnancy and After Birth
Speaker: Paula M. Alexa
Type: Oral presentation

Conference 3

Conference: Congresului Naţional de Medicină Perinatală (May 2016)
Presentation Title: Pregnancy to Infancy: A Window of Opportunity to Improve Family Health Through Smoking Cessation
Speaker: Cristian I. Meghea
Type: Prezentare orală

Conference 4

Conference: 17th Annual Conference of the Society for Research on Nicotine and Tobacco (SRNT) Europe (September 2016)
Presentation Title: Postpartum smoking abstinence self-efficacy and partner supportive behaviors
Speaker: Cristian I. Meghea
Type: Prezentare poster

Conference 5

Conference: 17th Annual Conference of the Society for Research on Nicotine and Tobacco (SRNT) Europe (September 2016)
Presentation Title: Dyadic efficacy for smoking cessation in a sample of Romanian couples
Speaker: Cristian I. Meghea
Type: Prezentare poster

Conference 6

Conference: 17th Annual Conference of the Society for Research on Nicotine and Tobacco (SRNT) Europe (September 2016)
Presentation Title: Predictors of postnatal smoking relapse intent in a sample of Romanian couples
Speaker: Cristian I. Meghea
Type: Prezentare orală

Other achievements of the project team

Obtaining new funding. The preliminary results and the experience gained by implementing the PRISM project contributed to obtaining a new K01 funding, awarded to Dr. Cristian Meghea and the PRISM project team by the National Institutes of Health, United States, for a research project on smoking cessation in Romanian families. The project will be implemented in Cluj-Napoca, between December 1st 2014 and December 1st 2019.

Dissemination of the project and its results at European level. Participation of two members from the research team (Principal Investigator Cristian I. Meghea and PhD(c) candidate Alexandra Brînzaniuc) in the COST IS1405 Action: Building Intrapartum Research Through Health – an interdisciplinary whole system approach to understanding and contextualizing physiological labor and birth (BIRTH) will contribute to the dissemination of the project among European public health experts activating in the area of maternal and child health.