3. TELEPHONE COUNSELING FOR SMOKING CESSATION Meta-analysis of telephone counseling for smoking cessation confirmed a significant increase in cessation rates compared to controls (OR= 1.34, (1.19-1.51) (Lichtenstein et al., 1996). Telephone counseling for smoking cessation can be effective in ‘real-world’ settings (Zhu et al., 2002). Solomon (2000) found that a proactive telephone support intervention for pregnant smokers showed a non-significant association between treatment conditions and confirmed quits.

4. MOM & ME SMOKEFREE (MOMS) STUDY GOAL To increase the rate of smoking cessation by using a proactive telephone counseling program throughout pregnancy and after delivery, compared to a “best practice” control.

5. MOMS Study Components COUNSELING FRAMEWORK: 5 As COUNSELING THEORY: Transtheoretical Model of Change COUNSELING STYLE: Motivational Interviewing

9. MOMS DESIGN Tufts OB risk assessment/office referral forms received  Smoker enrolled by telephone (consent & BL survey) —————————®——————————   Intervention Best Practice Control Prenatal counseling calls Brief counseling call Pregnancy-targeted materials Pregnancy-targeted material Postnatal counseling call(s) Communication with OB  Evaluation End-of-pregnancy & postpartum surveys (cotinine)

12. ASSESS TOOL: Health Behavior and Decision-Making Worksheet I. CURRENT HEALTH BEHAVIORS Things I do to keep myself and my baby healthy Things I do that are not healthy for me or my baby II. THINGS I LIKE & DON’T LIKE ABOUT MY SMOKING Worries or concerns if I quit Benefits I hope to gain III. HEALTH CHANGES Changes I would like to make Reasons I want to make changes

14. Who has enrolled in MOMS? (n=355) Mean (sd) Age28.6 years (6.3) Gestation at baseline12.5 weeks (4.5) % White, non Hispanic90 Marital status Living with partner74 No partner4 Worked in past year88 Education Completed high school38 Some college +51 First pregnancy46 Felt depressed38

15. SMOKING BEHAVIOR AT BASELINE M (SD) Pre-pregnancy daily rate21.5 (8.4) Pre-pregnancy daily rate21.5 (8.4) Pregnancy daily rate10.5 (7.3) Pregnancy daily rate10.5 (7.3)% Significant decrease since pregnant63 Significant decrease since pregnant63 24-hour quit attempt since pregnant45 24-hour quit attempt since pregnant45 Stage: Preparation83 Stage: Preparation83

16. ENVIRONMENT & SUPPORT AT BASELINE % Partner who smokes66 Most of friends & family smoke43 Smokefree home39 Expected “a lot” of support from spouse 80 Expected “a lot” of support from friends/family 79 Support available “most-all” of the time Listen77 Advice69 Information56

17. CONFIDENCE AT BASELINE How confident are you…% Confident …that you could quit smoking if you decided you could do it? 75 …that you could handle being around others who are smoking without smoking?60 …that you would not smoking when in situations where you are angry, anxious, sad or depressed?47

18. SUMMARY Telephone counseling is a treatment strategy that should be considered as a treatment modality for pregnant smokers.