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The Use of Significant Reduction Rates to Evaluate Health Education Methods for Pregnant Smokers: A New Harm Reduction Behavioral Indicator?

Departments of Human Studies and Obstetrics/Gynecology at the University of Alabama at Birmingham, ALrwindsor{at}uab.edu

Chang Qing Li, MD, DrPH

Food and Drug Administration, Center for Drug Evaluation and Research, Rockville, MD

Neal Richard Boyd, Jr., EdD, MSPH

Personal Improvement Computers System Inc., Reston, VA

Katherine E. Hartmann, MD

University of North Carolina at Chapel Hill

This article evaluates the evidence to support the use of biochemical measurement of significant reduction (SR) rates among pregnant smokers as a new behavioral indicator of "harm reduction" (HR). The results of four studies—three randomized patient education clinical trials of pregnant smokers (Trials I, II, and III) and an epidemiological study (Study IV)—are presented. Among Trial I, II, and III cohorts of pregnant smokers, control group SR rates of 7% (I), 9% (II), and 20% (III) were increased among experimental groups to 17% (I), 18% (II), and 32% (III) by the same patient education methods. Analyses of infant birthweight data in Study IV found that a patient SR rate representing a 50% or more decrease between a baseline and follow-up test was associated with an increase in adjusted birthweight of 92 grams.

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