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Baby BEEP: A Randomized Controlled Trial of Nurses’ Individualized Social Support for Poor Rural Pregnant Smokers

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Abstract

Objectives We tested the effect of nurse-delivered telephone individualized social support (“Baby BEEP”) and eight mailed prenatal smoking cessation booklets singly and in combination (2 × 2 factorial design) on smoking cessation in low-income rural pregnant women (N = 695; 75% participation). Methods Participants randomized to Baby BEEP groups (n = 345) received weekly calls throughout pregnancy plus 24-7 beeper access. Saliva cotinine samples were collected monthly from all groups by other nurses at home visits up to 6 weeks post-delivery. Primary outcomes were point prevalence abstinence (cotinine < 30 ng/ml) in late pregnancy and post-delivery. Results Only 47 women were lost to follow-up. Intent-to-treat analyses showed no difference across intervention groups (17–22%, late pregnancy; 11–13.5%, postpartum), and no difference from the controls (17%, late pregnancy; 13%, postpartum). Post hoc analyses of study completers suggested a four percentage-point advantage for the intervention groups over controls in producing early and mid-pregnancy continuous abstainers. Partner smoking had no effect on late pregnancy abstinence (OR = 1.7, 95% CI = 0.95, 3.2), but post-delivery, the effect was pronounced (OR = 3.2, 95% CI = 1.8, 5.9). Conclusions High abstinence rates in the controls indicate the power of biologic monitoring and home visits to assess stress, support, depression, and intimate partner violence; these elements plus booklets were as effective as more intensive interventions. Targeting partners who smoke is needed.

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Acknowledgments

The project described was supported by Grant Number R01NR05313 from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institute of Health. Support for development and reproduction of the smoking cessation booklets was provided by the Division of Lung Diseases-National Heart, Lung, and Blood Institute; the University Of Texas School of Public Health; and the Agency for Health Care Policy and Research. A very special thanks goes to the Baby BEEP research team: Alette Comstock, RN, Jan Davis, RN, Jeffrey Gage, RN, PhD, Natalie McGrath, RN, Mandy Manderino, PhD, RN, Karen Rupright, RN, Barbara Tanner, RN, Richard Tayloe, and Karry Young, RN. Also a special thanks to the personnel at the 21 participating WIC clinics and of course, to all the women who agreed to participate in this trial.

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Authors and Affiliations

  1. Sinclair School of Nursing, University of Missouri, S327, Columbia, MO, 65203, USA

    Linda Bullock & Elizabeth Geden

  2. Department of Family and Community Medicine, University of Missouri Medical School, Columbia, MO, USA

    Kevin D. Everett

  3. Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX, USA

    Patricia Dolan Mullen

  4. Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Daniel R. Longo

  5. Department of Biostatistics, University of Missouri, Columbia, MO, USA

    Richard Madsen

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  1. Linda Bullock
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Correspondence to Linda Bullock.

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Bullock, L., Everett, K.D., Mullen, P.D. et al. Baby BEEP: A Randomized Controlled Trial of Nurses’ Individualized Social Support for Poor Rural Pregnant Smokers. Matern Child Health J 13, 395–406 (2009). https://doi.org/10.1007/s10995-008-0363-z

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