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Smoking Cessation Intervention

Dr. Taneisha Scheuermann will study the effectiveness of an incentive-enhanced text messaging program for smoking cessation.

Taneisha S. Scheuermann portrait

Taneisha S. Scheuermann, Ph.D.

  • Associate Professor, Population Health, KU School of Medicine
  • Research Project Lead, Implementation Science for Equity Center for Biomedical Research Excellence

Project Summary

Smoking is one of the leading causes of mortality in the United States. Pregnant women who smoke expose themselves and their babies to a myriad of known carcinogens and are at risk for poor pregnancy outcomes. Currently, smoking rates among pregnant women are 8% with even higher smoking prevalence among low-income women. Twelve percent of pregnant women enrolled in The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) smoke. Low-income pregnant women are also less likely to quit. Even though guidelines recommend treating tobacco use among pregnant women, most pregnant smokers do not receive smoking cessation counseling and only one in 10 receive referrals to cessation services or follow-up care.

WIC clinics are an ideal venue for initiating smoking cessation interventions for pregnant women. WIC serves approximately 40% of pregnant women and clinics have existing data systems to routinely document tobacco use. Effective smoking cessation interventions have been developed for pregnant women but quit rates are modest. Only a few intervention studies have focused on pregnant women enrolled in WIC, and one achieved significant, biochemically verified quit rates. Efforts to implement smoking cessation interventions programs in WIC show low sustainment and barriers such as time constraints among WIC staff and lack of referral resources and educational materials.

The goal of this research is to develop and evaluate a novel smoking cessation intervention for initiation in WIC clinics that enhances text message cessation support with remotely delivered incentives. Developing an effective and scalable intervention for the WIC context could improve health equity for low-income women. We will use implementation science in planning our intervention by conducting formative studies to ensure feasibility and acceptability among WIC stakeholders. First, we will conduct interviews to determine end-user perspectives on the intervention and implementation strategies and identify adaptations to the intervention prior to implementation, using the FRAME framework to catalogue adaptations.

Specific Aims:

  1. Adapt study components for use in a combined intervention among pregnant women and create support tools for participants. We will conduct semi-structured interviews and user testing with 15 pregnant smokers. In this aim, we will identify WIC participants' preferences and needed adaptations to intervention components. Effective contingency management relies on accurate and timely assessment of smoking status. We will determine how best to train WIC-enrolled women to use the Insight mobile app that remotely assesses smoking status via exhaled carbon monoxide (CO) monitoring and delivers incentives. Our Aim 1 findings will be used to refine the intervention and develop a brief video training and materials for study participants to correctly use the app and CO device.
  2. Engage WIC stakeholders to develop implementation strategies for identifying and referring women to the study. We will conduct 12 -15 semi-structured interviews with WIC administrators and clinical staff to obtain feedback on the text + incentives intervention and recommendations for identification and referral systems for pregnant smokers. Based on our Aim 2 findings, we will refine our screening and referral processes and develop an implementation toolkit and training video for WIC staff.
  3. Test the preliminary effectiveness of an enhanced text message + incentives intervention for WIC-enrolled pregnant women in a two-arm pilot trial. We will compare the effects of two conditions: (1) text messaging + incentives versus (2) text messaging only. Primary outcomes will be smoking abstinence at 12 weeks post-randomization, feasibility, and acceptability from the perspectives of women enrolled in WIC and WIC staff. Our secondary outcomes include smoking abstinence at 6 months post-randomization.

This study is significant because it addresses tobacco use among pregnant women at high risk for continued smoking and smoking relapse. This proposed research is innovative as it combines incentives, an intervention yielding one of the highest effect sizes for smoking cessation in pregnant women, with text message cessation support which enhances the potential for both effectiveness and reach. This COBRE project data will support an R01 application for a Hybrid Type I study with a fully powered randomized controlled trial of an incentive enhanced smoking cessation text messaging intervention. This research program will impact the field by developing a scalable smoking cessation intervention for implementation in programs reaching a large proportion of low-income pregnant women.

Implementation Science for Equity COBRE

Implementation Science for Equity COBRE
Population Health
University of Kansas Medical Center
Mail Stop 1008
3901 Rainbow Boulevard
Kansas City, KS 66160
913-588-2734