Tailored Videos to Reduce Tobacco Smoke Exposure Among Pregnant Women and Newborns

BACKGROUND:

The Healthy People 2010 Objectives address the importance of smoking cessation during
pregnancy and the importance of reducing ETS exposure among children and adults. This study
will use a new combination of existing technologies to maximize the appropriateness of
prenatal and postpartum education concerning ETS exposure in an innovative, inexpensive, and
widely applicable approach. The use of tailored DVDs is practical, feasible, and inexpensive
enough to be attractive to clinics serving low-income and minority women. A large number of
video segments will be produced utilizing live actors, animation, and word slates. About 10
segments will be computer-selected for the videos for each woman based on her responses to
four self-assessments. No studies to date have included multiple doses of tailored video
education, or used DVDs in this way.

DESIGN NARRATIVE:

This two-arm randomized study is designed to develop and evaluate the efficacy of five
tailored DVDs in reducing exposure to ETS among low-income pregnant/postpartum women. The
overall purposes of the study are 1) to develop an innovative intervention (tailored
"take-home" DVDs) to help pregnant women maximize their pregnancy outcome and their new
infant's health through reduction in exposure to ETS and 2) to study the feasibility and
efficacy of this intervention compared with a usual care group. This innovative technology
will be field tested in collaboration with six prenatal clinics that serve primarily
low-income, African American, Latina, and minority women to address two specific aims.
Specific aim 1: To test the efficacy of tailored video (TV) versus usual care (UC)
approaches in terms of reducing the ETS exposure among fetuses of nonsmoking, low-income
women during pregnancy (assessed at 34 weeks gestation using saliva cotinine concentration
and ETS self-report) and among infants (as measured by saliva cotinine concentration and
mothers' self-reports at 6 months postpartum). Specific aim 2: To test the efficacy of TV
versus UC approaches in terms of reducing the exposure of the fetuses of low-income, smoking
women to tobacco smoke during pregnancy (assessed at 34 weeks gestation using saliva
cotinine concentrations of the pregnant women and smoking and ETS self-reports) and to their
infants (as measured by saliva cotinine concentration from the infant at 6 months postpartum
and self-reports of infant exposure by the new mothers). Because of the lack of data on
reducing ETS exposure amongst low-income and minority women, intensive formative and
extensive process evaluation components are included.

Inclusion Criteria:

- Women who attend their first prenatal visit by 16 weeks gestation

- Women exposed to tobacco smoke daily

Exclusion Criteria:

- Women expecting complications or multiple births