title: Randomized comparison of group versus individual educational interventions for pregnant women to reduce their secondhand smoke exposure.
abstract: BACKGROUND
  Secondhand smoke (SHS) exposure is deleterious to pregnant women and their unborn children. The prevalence of SHS exposure among pregnant women is particularly high in many Asian countries where approximately half of the male population smokes. We aim to investigate the efficacy of an intervention based on an expanded Health Belief Model (HBM) incorporating self-efficacy to educate and empower pregnant women to reduce their SHS exposure.
  
  
  METHODS
  We conducted a 3-arm randomized controlled trial (N = 50 in each arm) comparing the effectiveness of group-based and individual-based interventions with a treatment-as-usual group. A questionnaire tapping into constructs of the expanded HBM was administered at baseline and 1- and 2-month follow-ups. Exhaled carbon monoxide was used to determine SHS exposure (>=6 ppm). ANOVA was used to compare HBM construct scores, self-efficacy for rejecting SHS exposure, and SHS rejection behavior among the 3 groups at baseline and the 1- and 2-month follow-ups, while logistic regression analysis was used to compare the risk of exposure to SHS at each follow-up.
  
  
  RESULTS
  The group-based intervention significantly improved health beliefs, self-efficacy, and self-reported rejection behaviors. The individual-based intervention effect was limited to some health belief constructs and SHS rejection behaviors. Both group- and individual-based interventions showed significant reductions in SHS exposure 2 months after the intervention (P < 0.0001).
  
  
  CONCLUSIONS
  Group-based educational interventions based on the HBM are particularly effective in training pregnant women to avoid and refuse exposure to SHS. Policy makers should consider offering group-delivered programs to educate and empower pregnant women to reduce their SHS exposure.
authors.affiliation: Department of Education and Research, Taipei City Hospital Department of Information Management, University of Kang Ning, Taipei City, Taiwan Department of Social Work and Social Administration Hong Kong Jockey Club Center for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China (SAR) Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung Department of Optometry, Chung Hwa University of Medical Technology, Tainan Institute of Public Health and Department of Public Health, National Yang-Ming University Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan.
authors.forename: Ying-Chen
authors.initials: YC
authors.lastname: Chi
authors.forename: Feng
authors.initials: F
authors.lastname: Sha
authors.forename: Paul S F
authors.initials: PSF
authors.lastname: Yip
authors.forename: Jiunn-Liang
authors.initials: JL
authors.lastname: Chen
authors.forename: Ying-Yeh
authors.initials: YY
authors.lastname: Chen
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D057566:Self Report; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000517:prevention & control* / Q000706:statistics & numerical data
chemical_list: D014028:Tobacco Smoke Pollution