Original Article Nicotine Addiction in Pregnancy: Preliminary Efficacy of a Mental Health Intervention Ann R. Peden, ARNP-CS, DSN, Mary Kay Rayens, PhD, Lynne A. Hall, RN, DrPH, Ellen Hahn, RN, DNS, Carol Riker, RN, MSN, Kristin Ashford, ARNP, MSN, and Mei Zhang, MSN, MPH, RN Abstract Objectives: Depression is a significant predictor of smoking during pregnancy. The primary objective of this pilot study was to obtain preliminary data on the effects of a cognitive-behavioral group and telephone intervention during and after pregnancy on women’s smoking and quit rates, nicotine dependence, and mental health. Methods: A quasi-experimental, 2-group repeated measures design was used. Data were collected at baseline, 1 month after the group intervention and 2 and 4 months postpartum. The treatment group (n = 11) received the intervention during and immediately after pregnancy. The control group (n = 5) only responded to in-person interviews. Results: Although the groups were similar at baseline, the treatment group had fewer depressive symptoms and thoughts of hopelessness than the controls at the first postintervention interview. Cigarette use and nicotine dependence did not change significantly. Conclusions: This exploratory study supports the effectiveness of a mental health intervention in decreasing depressive symptoms and hopelessness among pregnant smokers. Improving the mental health of pregnant smokers may be an important compo- nent of smoking cessation. Key Words: tobacco use in pregnancy, mental health intervention, cognitive-behavioral interven- tions (Addict Disord Their Treatment 2008;7:179–189) C igarette smoking in pregnancy has many maternal and fetal risks includ- ing miscarriages, low-birth weight infants, preterm deliveries, still births, and neonatal deaths. Most of the mothers who quit smok- ing during pregnancy have intentions to remain smoke-free postpartum; however, smoking cessation interventions repeatedly fail to achieve postpartum smoking absti- nence. 1 Although motivation to quit smok- ing during pregnancy is high, only one third of pregnant women who stop smoking dur- ing pregnancy remain smoke-free 1 year after delivery. 1,2 The specific aim of this pilot study was to test the effects of a cognitive- behavioral group and telephone interven- tion during pregnancy and the postpartum period on women’s smoking and quit rates, nicotine dependence, and mental health. Tobacco is the single most modifiable cause of poor pregnancy outcomes. Although national cessation rates during pregnancy have dropped, postpartum re- lapse rates remain consistently high. 3 Post- partum smoking relapse within 1 year after delivery has been reported as high as 85%, and of those who relapse, 67% resume smoking at 3 months, and up to 90% by 6 months. 4 Throughout the past 2 decades, research has been conducted to evaluate prenatal and postnatal smoking cessation programs. 5 Many studies have only exam- ined cessation in the context of the woman’s pregnancy, excluding the period after the birth of the child. Other studies have included relapse prevention interventions in the prenatal period, but do not carry the intervention into the postpartum period. 6 Unfortunately, even fewer studies offer ADDICTIVE DISORDERS & THEIR TREATMENT Volume 7, Number 4 December 2008 179 From the College of Nursing, University of Kentucky, Lexington, KY. Funded by a University of Kentucky Faculty Research Support Program Grant. Reprints: Dr Ann R. Peden, ARNP-CS, DSN, College of Nursing, University of Kentucky, 760 Rose Street, Lexington, KY 40536-0232 (e-mail: arpede01@email.uky.edu). Copyright r 2008 by Lippincott Williams & Wilkins