title: A randomized trial of computer-delivered brief intervention and low-intensity contingency management for smoking during pregnancy.
abstract: BACKGROUND
  Implementation of evidence-based interventions for smoking during pregnancy is challenging. We developed 2 highly replicable interventions for smoking during pregnancy: (a) a computer-delivered 5As-based brief intervention (CD-5As) and (b) a computer-assisted, simplified, and low-intensity contingency management (CM-Lite).
  
  
  METHODS
  A sample of 110 primarily Black pregnant women reporting smoking in the past week were recruited from prenatal care clinics and randomly assigned to CD-5As (n = 26), CM-Lite (n = 28), CD-5As plus CM-Lite (n = 30), or treatment as usual (n = 26). Self-report of smoking, urine cotinine, and breath CO were measured 10 weeks following randomization.
  
  
  RESULTS
  Participants rated both interventions highly (e.g., 87.5% of CD-5As participants reported increases in likelihood of quitting), but most CM-Lite participants did not initiate reinforcement sessions and did not show increased abstinence. CD-5As led to increased abstinence as measured by cotinine (43.5% cotinine negative vs. 17.4%; odds ratio [OR] = 10.1, p = .02) but not for CO-confirmed 7-day point prevalence (30.4% abstinent vs. 8.7%; OR = 5.7, p = .06). Collapsing across CM-Lite status, participants receiving the CD-5As intervention were more likely to talk to a doctor or nurse about their smoking (60.5% vs. 30.8%; OR = 3.0, p = .02).
  
  
  CONCLUSIONS
  Low-intensity participant-initiated CM did not affect smoking in this sample, but the CD-5As intervention was successful in increasing abstinence during pregnancy. Further research should seek to replicate these results in larger and more diverse samples. Should CD-5As continue to prove efficacious, it could greatly increase the proportion of pregnant smokers who receive an evidence-based brief intervention.
authors.affiliation: Merrrill Palmer Skillman Institute, Wayne State University, Detroit, MI 48202, USA. s.ondersma@wayne.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Ondersma
authors.forename: Dace S
authors.initials: DS
authors.lastname: Svikis
authors.forename: Phebe K
authors.initials: PK
authors.lastname: Lam
authors.forename: Veronica S
authors.initials: VS
authors.lastname: Connors-Burge
authors.forename: David M
authors.initials: DM
authors.lastname: Ledgerwood
authors.forename: John A
authors.initials: JA
authors.lastname: Hopper
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D009042:Motivation; D016017:Odds Ratio; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention