Racial/Ethnic Disparities Impact the Real-World Effectiveness of a Multicomponent Maternal Smoking Cessation Program: Findings from the CTTP Cohort

Introduction Smoking during pregnancy adversely affects perinatal outcomes for both women and infants. We conducted a retrospective cohort study of the state-funded Comprehensive Tobacco Treatment Program (CTTP) – the largest maternal tobacco cessation program in San Bernardino County, California – to determine the real-world program effectiveness and to identify variables that can potentially improve effectiveness. Methods During 2012-2019, women who smoked during pregnancy were enrolled in CTTP’s multicomponent behavioral smoking cessation program that implemented components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). Results We found that 40.1% achieved prolonged abstinence by achieving weekly, cotinine-verified, 7-day abstinence during 6 to 8 weeks of enrollment. Using intention-to-treat analyses, we computed that the self-reported point prevalence abstinence rate (PPA) at the six-month telephone follow-up was 36.7%. Cohort members achieving prolonged abstinence during the CTTP were five times more likely to achieve PPA six months after CTTP. Several non-Hispanic ethnicities (Black, Native American, White, or More than one ethnicity) in the cohort were two-fold less likely (relative to Hispanics) to achieve prolonged abstinence during CTTP or PPA at six months after CTTP. This disparity was further investigated in mediation analysis. Variables such as quitting during the first trimester and smoking fewer cigarettes at enrollment were also associated with achieving PPA at six months. Discussion Racial/ethnic health disparities that have long been linked to a higher rate of maternal smoking persist even when the pregnant smoker enrolls in a smoking cessation program. Significance What is already known on this subject? Causal factors that enable pregnant smokers to achieve abstinence during and after enrollment in maternal smoking cessation programs are not well understood. What does this study add? We found that US (United States) racial/ethnic disparities that have long been linked to higher national rates of maternal smoking for several non-Hispanic ethnicities (Black, Native American/Alaskan, White) also persisted in the form of lower abstinence rates in non-Hispanic ethnicities (Black, Native American, White, More than one ethnicity) who enrolled in the maternal smoking cessation program we evaluated. This racial/ethnic disparity in maternal smoking cessation program outcomes is a new addition to the literature and needs further study to identify the underlying causal factors.