ABSTRACT
Smoking during pregnancy is a leading preventable cause of poor pregnancy outcomes. Financial incentives interventions yield quit rates of approximately 30% during pregnancy, versus ~4% in traditional smoking cessation programs. This pilot study assessed the feasibility of translating an efficacious University of Vermont research-based intervention into a rural community setting delivered by the Vermont Department of Health. Pregnant women using tobacco products were recruited from the Women, Infants and Children program and Rutland Women's Healthcare. Women were provided in-person tobacco cessation counseling during regularly scheduled meetings and received gift cards throughout pregnancy and 3 months postpartum contingent upon biochemically verified smoking abstinence. Cessation counseling and abstinence monitoring began with high frequency (three visits per week), tapering through postpartum to biweekly visits. Gift card values began at $15, increasing by $5 for consecutive negative samples, to $40 maximum. Participants completed three surveys (enrollment, 4-6 weeks postpartum, 6-12 months postpartum) assessing smoking habits, and barriers and facilitators of treatment engagement and success. From 2018 to 2020, we enrolled 20 pregnant women, of whom six self-reported quitting tobacco at some point during the intervention. At study completion, three reported sustained abstinence. Results suggest that it is feasible to translate a research-based smoking cessation program into a community setting. This article discusses the challenges faced and the lessons learned when implementing research in a rural community setting, recruiting and retaining participants, and adapting protocols during the Covid-19 pandemic.
ABSTRACT
BACKGROUND: This study examined the impact of COVID-related disruptions on mental health and substance use in young people residing in a state with an initially lower COVID burden and earlier reopening of in-person learning than other states. METHODS: Data come from Waves 3 (Fall 2019) and 4 (Fall 2020) of the Policy and Communication Evaluation (PACE) Vermont, an online cohort study of adolescents (ages 12-17) and young adults (ages 18-25). Participants in Wave 4 (212 adolescents; 662 young adults) completed items on COVID-related stressors, the impact of the pandemic on their substance use, brief mental health scales, and past 30-day substance use. Analyses examined correlational and longitudinal relationships between COVID-related stressors, mental health symptoms, and substance use. RESULTS: More than 60% of participants noted negative effects of the pandemic on their physical, emotional, and social well-being, with greater impacts of COVID-related stressors in young adults than adolescents. There were significant increases in depressive (OR 1.31, 95% CI 1.03, 1.66) and anxiety symptoms (OR 1.34; 95% CI 1.10, 1.64) in young adults between Fall 2019 and Fall 2020. Higher overall COVID Impact scores were associated with higher odds of depressive and anxiety symptoms, as well as past 30-day electronic vapor product use, in adjusted cross-sectional and longitudinal models. CONCLUSIONS: Robust associations between COVID-related distress, mental health, and substance use outcomes in young people signal the opportunity to increase evidence-based interventions while adding novel approaches to minimize longer-term harms of the pandemic on mental health in adolescents and young adults.