Abstract
BackgroundHome visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied.MethodsMixed methods approach using a retrospective cohort of propensity score matched home visiting clients and local-area comparison women with first births between 2008–2014 in a large Northeast state. Multivariable logistic and linear regression estimated third trimester prenatal tobacco smoking cessation and reduction. Additionally, qualitative interviews were conducted with 76 home visiting clients.ResultsA program effect was seen for smoking cessation such that clients who smoked less than ten cigarettes per day and those who smoked 20 or more cigarettes per day during the first trimester were more likely to achieve third trimester cessation than comparison women (p <0.01 and p = 0.01, respectively). Only for heavy smokers (20 or more cigarettes during the first trimester) was there a significant reduction in number of cigarettes smoked by the third trimester versus comparison women (p = 0.01). Clients expressed the difficulty of cessation, but addressed several harm-reduction strategies including reducing smoking in the house and wearing a smoking jacket. Clients also described smoking education that empowered them to ask others to not smoke or adopt other harm reducing behaviors when around their children.ConclusionsWhile a significant impact on smoking cessation was seen, this study finds a less-clear impact on smoking reduction among women in home visiting programs. As home visiting programs continue to expand, it will be important to best identify effective ways to support tobacco-related harm reduction within vulnerable families.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3464-4) contains supplementary material, which is available to authorized users.
Highlights
Home visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied
This study provides an in-depth analysis of the intersection between home visitation and smoking behaviors using a mixed-methods approach with data from the Pennsylvania MIECHV Evaluation
We explore the program effect of home visiting on smoking cessation and reduction between the first and third trimester of pregnancy using quantitative data from the Nurse Family Partnership (NFP) home visiting program
Summary
Home visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied. Evidence-based prenatal smoking cessation programs are an important public health intervention for minimizing. Home visiting programs are uniquely positioned to reduce prenatal smoking. These programs have a strong evidence base for child well-being outcomes, including improved health care utilization and school readiness [8]. While researchers have demonstrated increased rates of smoking cessation among participants of home visiting programs, research exploring other ways home visiting programs impact prenatal smoking behaviors is lacking
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