Predictors of program participation and behavior change among pregnant women in the West Virginia-Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Dissemination Program
Open AccessBackground: Smoking during pregnancy remains a salient public health problem, particularly for low-income, Medicaid-insured pregnant women. There is an absence of research on what behavioral and psychosocial factors, including prenatal depression and nicotine dependence, affect enrollment in home-based smoking cessation programs and smoking behavior change among pregnant women. The purpose of this study was to examine predictors of program participation and behavior change among a representative cohort of Medicaid-insured pregnant women from the West Virginia Right From the Start (WV-RFTS) program who enrolled in the West Virginia Smoking Cessation and Reduction in Pregnancy Treatment (WV-SCRIPT) Program (n=857) in 2009 and 2010.Methods: Bivariate, multinomial and ordered logistic regression models were used to test the effects of prenatal depression and nicotine dependence on SCRIPT enrollment and on smoking behavior change (cessation and significant reduction). Prenatal depression was measured using the Edinburgh Postnatal Depression Scale (EPDS). Nicotine dependence was measured with the two-item Heavy Smoking Index (HSI), as well as an expanded, eight-item Continued Smoking Risk Factor Index (CSRF-I).Results: No association was found between depression scores and SCRIPT enrollment (p=0.22, OR=1.10), although RFTS clients with high depression scores were significantly more likely to enroll in SCRIPT (p=0.02, OR=1.61). Perceived self-efficacy in quitting (p<0.01, OR=1.09) and self-reported number of cigarettes smoked per day (p=0.01, OR=0.96) were independent predictors of SCRIPT enrollment. RFTS clients with high depression scores were 50% less likely to change their smoking behavior, although this association was not significant (OR=0.47). Nicotine dependence as measured by both the HSI and CSRF-I was significantly associated with SCRIPT enrollment, although this relationship was largely mediated by perceived self-efficacy in quitting. After controlling for self-efficacy, the effect of HSI score on cessation and significant reduction was not significant, and was partially mediated by self-efficacy. The effect of CSRF-I score on cessation was significant, although the effect of CSRF-I score on significant reduction was partially mediated by self-efficacy. Conclusions: Public health providers may wish to provide additional support for clients with higher depression scores and stronger nicotine dependence symptoms. The use of a nicotine dependence index, while time-intensive, may allow them a quantifiable measure for which clients need more attention and cessation assistance. Health promotion program staff may wish to encourage significant reduction as an alternative for highly dependent clients who have difficulty quitting.
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