Education and Counseling for Abstinence From Tobacco After Pregnancy

BACKGROUND:

Pregnancy is an ideal time to help underserved young women to stop smoking cigarettes and
remain abstinent for life. The field has made great progress in assisting women to quit
during this time. Unfortunately, maintenance of this highly significant behavior change is
dismal. Up to 75% of those who quit for pregnancy end up returning to smoking after delivery
of the newborn. For underserved women, pregnancy is one of the few times that they have an
extended contact with the health care system. Therefore, there is an opportunity to help
these women quit smoking for the health of their fetus in addition to their own health. To
date, there has been insufficient research on how best to maintain abstinence during the
critical postpartum period, during which a unique constellation of risk factors (including
sleep deprivation, variations in negative mood, and increased stress) heighten the
probability of relapse. The potential payoff is enormous. The literature, while not
extensive, provides sufficient guidance and justification for the specific approach and
intervention components the study has chosen.

DESIGN NARRATIVE:

This study will develop and field test a maintenance of smoking abstinence program to be
designed for a predominately low-income, high-risk population of women from a wide variety
of ethnic and racial backgrounds who have quit smoking because of (or during) their
pregnancy. The study will compare biologically confirmed postpartum smoking relapse rates of
women who receive an educational intervention during pregnancy combined with sustained
telephone counseling after that intervention, with women who receive only an educational
intervention. Participants will begin at 28 weeks prenatal and will be followed through 1,
3, 6, and 12 months postpartum.

The specific aims of the current maintenance study are: 1) to compare biochemically
confirmed smoking abstinence rates of women who quit smoking during their pregnancy and who
receive an intervention based on telephone counseling using motivational interviewing versus
quitters who receive usual care, maintenance of abstinence will be assessed at 1, 3, 6, and
12 months postpartum; and 2) to collect both qualitative and quantitative data to better
understand short term and long term maintenance mediators and moderators of abstinence
postpartum for women of low socioeconomic status (SES) who quit smoking during pregnancy.

Inclusion Criteria:

- Smoked tobacco immediately before pregnancy

Exclusion Criteria:

- Smoked tobacco in the previous 7 days when contacted at 28 weeks gestation

- No telephone access