Evidence Report/Technology Assessment Number 214 Smoking Cessation Interventions in Pregnancy and Postpartum Care Evidence-Based Practice Evidence Report/Technology Assessment Number 214 Smoking Cessation Interventions in Pregnancy and Postpartum Care Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10065-I Prepared by: Vanderbilt Evidence-based Practice Center Nashville, TN Investigators: Frances E. Likis, Dr.P.H., N.P., CNM Jeffrey C. Andrews, M.D. Christopher J. Fonnesbeck, Ph.D. Katherine E. Hartmann, M.D., Ph.D. Rebecca N. Jerome, M.L.I.S., M.P.H. Shannon A. Potter, M.L.I.S. Tanya S. Surawicz, M.P.H. Melissa L. McPheeters, Ph.D., M.P.H. AHRQ Publication No. 14-E001-EF February 2014 This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10065-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This report may periodically be assessed for the urgency to update. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at: www.effectivehealthcare.ahrq.gov. Search on the title of the report. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Likis FE, Andrews JC, Fonnesbeck CJ, Hartmann KE, Jerome RN, Potter SA, Surawicz TS, McPheeters ML. Smoking Cessation Interventions in Pregnancy and Postpartum Care. Evidence Report/Technology Assessment No.214. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 14-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2014. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an e- mail list to learn about new program products and opportunities for input. We welcome comments on this systematic review. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Richard G. Kronick, Ph.D. Jean Slutsky, P.A., M.S.P.H. Director, Agency for Healthcare Research Director, Center for Outcomes and Evidence and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Suchitra Iyer, Ph.D. Director, EPC Program Task Order Officer Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments We are indebted to an exceptional group of colleagues who made this report possible. Each step of a systematic review draws on the skills and attention of an entire team. The authors gratefully acknowledge the following individuals for their contributions to this project: Ms. Sanura Latham and Ms. Hollie Black assisted with formatting, data entry, and article retrieval. Ms. Nila Sathe provided guidance on logistics of the review process and organization of the report. Technical Expert Panel In designing the study questions and methodology at the outset of this report, the EPC consulted several technical and content experts. Broad expertise and perspectives are sought. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who participated in developing this report follows: Susan A. Albrecht, Ph.D., CRNP, FAAN University of Pittsburgh Pittsburgh, PA Timothy J. Coleman, M.D. University of Nottingham Nottingham, England Beth Collins Sharp, Ph.D., R.N. Women’s Health and Gender Research Agency for Healthcare Research and Quality Rockville, MD Denise Dougherty, Ph.D. Extramural Research, Education and Priority Populations Agency for Healthcare Research and Quality Rockville, MD iv Mary Ann Faucher, CNM, M.P.H., Ph.D., FACNM Baylor University Waco, TX Stephen T. Higgins, Ph.D. University of Vermont Burlington, VT Evan R. Myers, M.D., M.P.H. Duke University Medical Center Durham, NC Sharon T. Phelan, M.D., FACOG University of New Mexico School of Medicine Albuquerque, NM Leah M. Ranney, Ph.D. University of North Carolina at Chapel Hill Chapel Hills, NC Richard A. Windsor, Ph.D., M.S., M.P.H. George Washington University Medical Center Washington, DC v Peer Reviewers Prior to publication of the final evidence report, EPCs sought input from independent Peer Reviewers without financial conflicts of interest. However, the conclusions and synthesis of the scientific literature presented in this report do not necessarily represent the views of individual reviewers. Peer Reviewers must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential nonfinancial conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential nonfinancial conflicts of interest identified. The list of Peer Reviewers follows: Sue Cooper, Ph.D. University of Nottingham Nottingham, England Janice Gomersall, M.D. Medicaid Medical Directors Learning Network Missoula, MT Suzanne G. Haynes, Ph.D. Department of Health and Human Services Office on Women’s Health Washington, DC Jennifer Prah Ruger, Ph.D., M.Sc., M.A., M.S.L. University of Pennsylvania Perelman School of Medicine Philadelphia, PA Mary Ellen Wewers, R.N., Ph.D., M.P.H. Ohio State University Columbus, OH vi Smoking Cessation Interventions in Pregnancy and Postpartum Care Structured Abstract Objective. The Vanderbilt Evidence-based Practice Center systematically reviewed evidence about smoking cessation interventions in pregnant and postpartum women. Data sources. We searched MEDLINE®,