BMJ  2005;331:373-377 (13 August), doi:10.1136/bmj.331.7513.373

Paper

Randomised controlled trial of home based motivational interviewing by midwives to help pregnant smokers quit or cut down

¹ Paediatric Epidemiology and Community Health Unit, Department of Child Health, Division of Developmental Medicine, University of Glasgow, Yorkhill, Glasgow G3 8SJ, ² Section of Obstetrics and Gynaecology, Division of Developmental Medicine, University of Glasgow, Glasgow G31 2ER, ³ Section for Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, Glasgow G12 8RZ, ⁴ NHS Health Scotland, Clifton House, Glasgow G3 7LS, ⁵ International Non Governmental Coalition Against Tobacco, PO Box 42134, London SW8 4WS, ⁶ Haematology Department, Yorkhill Hospital, Glasgow G3 8SJ

Objective To determine whether motivational interviewing—a behavioural therapy for addictions—provided at home by specially trained midwives helps pregnant smokers to quit.

Design Randomised controlled non-blinded trial analysed by intention to treat.

Setting Clinics attached to two maternity hospitals in Glasgow.

Participants 762/1684 pregnant women who were regular smokers at antenatal booking: 351 in intervention group and 411 in control group.

Interventions All women received standard health promotion information. Women in the intervention group were offered motivational interviewing at home. All interviews were recorded.

Main outcome measures Self reported smoking cessation verified by plasma or salivary cotinine concentration.

Results 17/351 (4.8%) women in the intervention group stopped smoking (according to self report and serum cotinine concentration < 13.7 ng/ml) compared with 19/411(4.6%) in the control group. Fifteen (4.2%) women in the intervention group cut down (self report and cotinine concentration less than half that at booking) compared with 26 (6.3%) in the control group. Fewer women in the intervention group reported smoking more (18 (5.1%) v 44 (10.7%); relative risk 0.48, 95% confidence interval 0.28 to 0.81). Birth weight did not differ significantly (mean 3078 g v 3048 g).

Conclusion Good quality motivational interviewing did not significantly increase smoking cessation among pregnant women.

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Rapid Responses:

Read all Rapid Responses

Nature of the motivational interviewing and quality of its external quality assessment

John F Morgan
bmj.com, 13 Aug 2005 [Full text]

Behavioral interventions can be effective

John R. Polito
bmj.com, 14 Aug 2005 [Full text]

Lots of possible explanations

Malcolm I Thomas
bmj.com, 15 Aug 2005 [Full text]

Behavioural interventions must be multileveled in areas of deprivation

Vanessa K Rose
bmj.com, 16 Aug 2005 [Full text]

Authors Reply: Teaching midwives motivational interviewing for a randomised controlled trial

Jeff Allison, et al.
bmj.com, 29 Aug 2005 [Full text]

Re: Authors Reply: Teaching midwives motivational interviewing for a randomised controlled trial

John F Morgan
bmj.com, 30 Aug 2005 [Full text]

Smoking Cessation in core curricula –critiquing and using appropriate interventions.

Ann M Wylie
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