Kicking the habit


A new smoking cessation initiative in rural Indiana helps moms quit to improve their health and the health of their babies.

Indiana University researchers and rural healthcare providers are working together to encourage pregnant women to quit smoking with a two-year study in partnership with the IU Center for Rural Engagement.

Jon Macy, an associate professor at the Indiana University School of Public Health-Bloomington, is examining financial incentive as a method to reduce smoking by pregnant women in southern Indiana. The study focuses on pregnant women because of pregnancy’s clear timeline and smoking’s elevated health risk to pregnant women. “We have an unacceptably high rate of smoking during pregnancy in Indiana,” Macy says.

According to the Indiana Department of Health, 11.8 percent of pregnant women in Indiana were smokers in 2018, more than double the national average of 5.6 percent in the same year. But that number is a significant drop from 18.5 percent in 2007, thanks to the many efforts by groups throughout Indiana to help people quit.

The study is being conducted in partnership with Southern Indiana Community Health Care (SICHC). Donna Charles, a licensed practical nurse, heads what they call the “You Can Do It” smoking cessation project. Charles says personal experience with smoking during college helps her in this role. “It was either smoke or eat everything in sight while studying,” she says. She quit smoking after graduating, but picked it back up during a stressful period later in her life. But, she managed to quit again. “It was not easy to quit this time, but I did, cold turkey.”

This affects the baby’s growth and development and causes the baby’s heart to beat harder every time [the mother] smokes.

Donna Charles, Southern Indiana Community Health Care

Charles worked with Macy’s team to help build the program. “During the first year, SICHC assisted the IU research team in developing the protocol for the project, including guidance on implementation, survey development, and recruitment methods and processes,” she says.

Beginning in August 2019, the study team tested the effectiveness of financial incentive to prevent smoking in a group of 31 pregnant women from Orange and Crawford counties. At obstetric visits, participants are tested with a ‘Smokerlyzer,’ a carbon monoxide (CO) detector that checks the amount of CO in their blood and lungs. For each time their CO level is at least one point lower than before, they are offered a $25 gift card. Charles says that smoking while pregnant limits the amount of oxygen the baby receives. “This affects the baby’s growth and development and causes the baby’s heart to beat harder every time [the mother] smokes,” she says.

“The response from our patients is positive and encouraging,” says Charles. “The patient wants to see if their CO level has lowered from before, especially if they have put in the effort to decrease or quit smoking.”

Initially, in the second year of the study, they planned to form another study group that includes 30 more pregnant smokers and their significant others if they are also smokers. However, restrictions on the number of people in SICHC locations due to COVID have delayed this.

The overall hope of the study is to see a reduction in smoking of 60 percent of both groups of women. “The project’s goal is to help women reduce their smoking or hopefully quit during their pregnancy and stay quit after the baby is born,” says Macy, but he also hopes that the study will show the method’s feasibility for all smokers. “Most smokers want to quit, but it is a very difficult thing to do,” he says. “If this can help some people quit or cut down, then I am happy.”

Macy says they have yet to analyze any study data, but anecdotal evidence from some participants suggests that it has helped them reduce smoking. Additionally, Macy’s previous study in other areas of Indiana showed women who had received the intervention delivered babies who weigh more, he says.

The study will be completed at the end of August 2021, but Macy says that this intervention strategy alone won’t go far enough to reduce smoking in Indiana. “To make a big difference in reducing smoking rates in Indiana ... we need to do things like raise the cigarette tax, ban menthol, and promote cessation and prevention messages with mass media campaigns.”

“I feel people will quit smoking when they are ready,” says Charles. “My suggestion would be once someone decides they want to quit smoking, set a date to stop completely and stick with that date, no matter what.”

The IU Center for Rural Engagement improves the lives of Hoosiers through collaborative initiatives that discover and deploy scalable and flexible solutions to common challenges facing rural communities. Working in full-spectrum community innovation through research, community-engaged teaching and student service, the center builds vision, harnesses assets and cultivates sustainable leadership structures within the communities with which it engages to ensure long-term success.