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.”

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.