Study Motivates Moms to Stay Smoke-Free

The decision to quit smoking is an easy one for many mothers-to-be. Almost half put down the cigarettes the moment they learn they're pregnant.

Unfortunately, about eight of every 10 women who quit during pregnancy light up again by their baby's first birthday. An M. D. Anderson research study called Project MOM is looking at ways to help women remain smoke-free after delivering their babies.

"You have all these women who have quit and are abstinent for eight months, so they're through withdrawal, but then they go back to smoking," says David Wetter, Ph.D., chair of M. D. Anderson's Department of Health Disparities Research and Project MOM principal investigator.

"The goal of this study is to capitalize on this tremendous public health opportunity by developing an intervention to help them avoid relapse."

Social stigma drives abstinence during pregnancy

The key is motivation. Pregnant women tend to be motivated to quit smoking by the desire to safeguard the health of their unborn baby and because the social pressures to quit are considerable. But following delivery that motivation may wane, and relapse often is the result.

"A lot of pregnant women quit because there are few behaviors as socially stigmatized as a pregnant woman sucking on a cigarette. So they quit, which is fantastic, but those reasons for quitting may not seem as important once their baby is born," Wetter explains.

Any life stress can lead to relapse

Project MOM is different from other programs because it assumes individuals are not consistently motivated to remain smoke-free.

A woman may be highly motivated to quit smoking and remain abstinent following her baby's birth, but a fight with her spouse or other stressful event may trigger a desire to smoke as a way of coping. "In a matter of 20 seconds, her motivation can just go through the floor," Wetter says.

So there is a need to maintain and strengthen new mothers' motivation despite potentially trying moments, as well as to educate them about the health risks smoking poses for their children.

Information combined with counseling

About 270 women, many representing minority and low socioeconomic groups, have taken part in Project MOM. They are randomly divided into three groups:

Usual Care- Participants receive brief advice to remain smoke-free, as well as self-help materials.

Motivational Relapse Prevention (MRP)- Participants receive therapy via six phone-based counseling calls.

MRP Plus- Participants receive telephone counseling and take part in two face-to-face visits with M. D. Anderson counselors.

The telephone counseling sessions, which last about 15 minutes, follow a detailed treatment manual but are highly individualized to focus on a woman's specific situation and the issues likely to affect her ability to remain abstinent. Factors such as stress, depression and proximity to smokers can play major roles.

Participants receive help with topics, including:

• Stress
• Depression
• Parenting
• Relationships
• Support systems

"We know all these things are issues for them - and also are causes of relapse," Wetter says. "So we may be able to help these women by addressing the general issues affecting their lives without an exclusive focus on smoking."

Patient says so far, so good

Not all mothers in the program will stay abstinent, but Meagan Chase of Houston hasn't smoked since she learned she was pregnant last year. She enrolled in Project MOM in December, when she was five months pregnant, and was placed in the MRP Plus group.

"I ended up being one of the people in the group with a counselor, and that has been a truly big help," Chase says. "While I thought I was strong enough, it's really good just to have someone you know you can talk to about the difficulty of quitting and staying smoke-free."

Like many other moms who quit during pregnancy, Chase has thought of smoking since her son, Phoenix, was born in May.

"There was a time after delivery when I wanted to reach for a cigarette, but I remember reading one of the handouts they had given me about nicotine and breast milk. Also, I knew I was going to have to talk to [the counselor] in another week, and I didn't want to have to tell her I smoked.'"

Women are eligible to take part in Project MOM if they:

• Are less than 34 weeks pregnant
• Are age 18 years or older
• Are able to speak, read and write in English

Participants also must have quit smoking no earlier than the second month of pregnancy.

For more information, please contact the M. D. Anderson Information Line at 1-800-392-1611, option 3.