The Quit for Keeps project (part of a cluster of ten projects called Smoke-Free Families) is a study designed to test the efficacy of using custom-tailored messages in convincing pregnant women to quit smoking.

cancer prevention, tobacco, smoking cessation, women, pregnancy

1. Develop a tailored survey delivered by personal digital assistant (Apple Newton) to pregnant smokers.
   
2. Develop tailored smoking cessation guides.
3. Conduct a randomized trial.

250 pregnant women from the University of North Carolina Obstetrics and Gynecology clinic (UNC OB/GYN) and Taubman obstetrics and gynecology (ob/gyn) clinic at the University of Michigan. Subjects are either smokers or women who have quit since becoming pregnant.

Using hand-held computers, patients will answer questions on behavioral and psychosocial variables, including: stages of change for quitting smoking, perceived benefits of and barriers to quitting and demographics. The hand-held computer will randomly assign newly enrolled participants to either the intervention or usual care (control) group.

Based on the data they provide that day, participants in the intervention care group will receive an individually tailored pregnancy guide and quit plan that will be sent to their home. In addition to smoking cessation information, tips and strategies, these messages will include pictures, suggestions and information about the developing fetus. Along with her guides, each woman in the innovative care group will receive a letter she can give to a support person, with information she thinks might help her effort to quit. Participants in the usual care group will receive standard, not tailored, smoking cessation materials. Data collected during this class will provide baseline measures against which outcome data will be compared.

Follow-up assessments will be completed approximately ten times in nine months: at baseline, during subsequent routine pre-natal visits, and in the hospital following delivery. The actual number of follow-up surveys is dependent on the timing of participant's initiation of pre-natal care, the risk level of the pregnancy, and delivery. Final data will be collected by phone three months post-partum for evaluation purposes. Self-reported smoking status will be biochemically verified for both groups throughout the program.

• 9.2% of the women who received untailored messages (control group) quit smoking, while 9.6% of the women who received tailored messages (intervention group) quit smoking. This difference was not significant.
• Overall, 90% of the subjects felt that the hand held computer was "very easy" to use and 90% felt "very comfortable" using a computer to answer difficult questions.
  
• Of the women in the intervention group, most (55%) considered the information they received to be useful, all felt that the materials addressed their reasons for smoking, 60% felt that their needs were addressed, and almost 70% believed their barriers were addressed in the information.

After completion of the research project, further studies are necessary in order to evaluate more fully the use of tailored smoking cessation materials for pregnant women.

Strecher VJ, Bishop KR, Bernhardt J, Thorp JM, Cheuvront B, Potts P. Quit for keeps: tailored smoking cessation guides for pregnancy and beyond. Tob Control. 2000;9 Suppl 3:III78-9.