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DISSERTATION ABSTRACT

Motivational enhancement therapy for cigarette smoking in methadone-maintained pregnant women
by Haug, Nancy Anne, Ph.D., University of Maryland, Baltimore County, 2002

Pregnant women who abuse drugs and smoke cigarettes are at especially high risk for health complications and present a major public health concern. Substance abuse treatment may be an ideal setting for smoking intervention with pregnant women. The current study compared Motivational Enhancement Therapy (MET) for increasing quit rates and reducing smoking during pregnancy to standard care practitioner advice in a two-group randomized experimental design. The Transtheoretical Model was incorporated as a conceptual framework for describing and predicting the behavior change process involved in pregnancy smoking. Participants were 63 pregnant female smokers seeking drug treatment and prenatal care. A majority of women were African-American, lower SES, single or never married, and smoked approximately 20 cigarettes per day. At 10-week follow-up, findings from self-report and bioassay measures indicated that the motivational intervention was not successful in eliminating or reducing smoking during pregnancy. One important finding is that MET impacted forward stage movement (i.e., precontemplation to contemplation). An association was found for depression such that individuals with a history of depression were more likely to increase smoking during pregnancy than women without lifetime depression. Intensive interventions, including nicotine replacement medications and innovative harm reduction strategies are recommended to address the barriers to quitting observed in this population.