Efficacy and cost-effectiveness of a clinic-based counseling intervention tested in an ethnically diverse sample of pregnant smokers.

OBJECTIVE: Rates of cigarette smoking are higher among women who receive obstetric care through publicly funded prenatal clinics. This study compared smoking outcomes for pregnant women (n=105) who were randomized to receive either usual care (standard cessation advice from the health care provider) or an intervention conducted in the prenatal clinic consisting of 1.5 h of counseling plus telephone follow-up delivered by a masters prepared mental health counselor. METHODS: Subjects were 105 low income, predominantly Hispanic, pregnant patients in an urban prenatal clinic. Smoking outcomes were assessed at end of pregnancy and 6 months post-partum. RESULTS: At follow-up, 28.3% and 9.4% of participants in the experimental intervention and 9.6% and 3.8% of patients in usual care were abstinent at end of pregnancy (p=.015) and 6 months post-partum, respectively (p=.251). Cost of the intervention was $56 per patient and cost to produce a non-smoker at end of pregnancy was $299. CONCLUSIONS: This model for intervention was cost-effective and was associated with significantly lower smoking rates at end of pregnancy. PRACTICAL IMPLICATIONS: If these findings are replicated, prenatal clinics could offer the option for intensive smoking cessation treatment by training mental health counselors to deliver one extended smoking cessation counseling session.

Urban ethnic minority women's attendance at health clinic vs. church based exercise programs.

Older, sedentary, urban-living, ethnic minority women are at high risk for preventable disease, but it is difficult to engage this population in health promotion efforts. This study tested two methods of engaging Hispanic and African American women, who were at high risk for cardiovascular disease, in a 10-week aerobic fitness program. The program was offered to 76 participants, in either a women's health clinic or a church. Attendance was the primary dependent variable and was recorded at each exercise session. Other variables, including the Baecke Questionnaire of Habitual Physical Activity, Fat Frequency Questionnaire, Self-Efficacy for Exercise Behaviors Scale, Social Support and Exercise Survey, and Psychological General Well-Being Schedule, were measured prior to the intervention, at the end of the 10-week program, and at 3-month follow-up. Age predicted attendance, independently of site. Women in the highest age quartile (50 - 70 years) attended more than twice as many exercise sessions compared to women in the lowest age quartile (17 - 27 years). The relationship between older age and attendance was particularly strong for Hispanic women. Church parishioners were primarily women over the age of 40, making it impossible to disentangle the relative effect of locale. These findings are relevant for clinicians who design exercise programs targeting older, ethnic, minority women. Administrators who design exercise programs for urban-living women should consider age of the target population when selecting the most conducive setting.