Brief reportCorrelates of postpartum smoking relapse: Results from the pregnancy risk assessment monitoring system (PRAMS)
Introduction
W omen often quit smoking during pregnancy (20% to 40%),1, 2, 3 but relapse to smoking after pregnancy is high (50% to 80% within 6 months).3, 4, 5, 6, 7 Many studies have examined predictors of quitting during pregnancy,1, 2, 5, 6, 8, 9, 10 but our understanding of predictors of return to smoking postpartum is limited.2, 3, 5, 11 A clearer understanding of correlates of postpartum relapse could assist in the design of effective interventions and contribute to long-term smoking cessation. This study examines the prevalence and intensity of smoking before, during, and after pregnancy, and identifies correlates of postpartum smoking relapse in a population-based sample of recent live births.
Section snippets
Methods
The Pregnancy Risk Assessment Monitoring System (PRAMS) collects data from women who recently delivered a live-born infant, using stratified, systematic samples (ranging from 100 to 250 per state per month) derived from birth certificates.12, 13 Questionnaires are mailed 2 to 6 months postpartum, and responses are linked with birth certificates. We examined data on births delivered in 1996 in the ten participating states with response rates of >70% (Arkansas, Alabama, Florida, Georgia, Maine,
Results
Most women in the study sample were aged 20 to 34 years (88.3%), Caucasian (76.8%), married (68.2%), and had at least a high school education (80.4%), and most entered prenatal care during the first trimester (87.2%). Most infants (99%) were 2 to 6 months old at the time of the survey; median age was 3.4 months.
Overall, 25.6% of women reported cigarette smoking before pregnancy (Table 1). Among women who smoked before pregnancy, 44.5% reported quitting during pregnancy
Discussion
Among women who reported quitting smoking during pregnancy, almost half relapsed to smoking within several months after delivery, which is in general agreement with previous studies.5, 7, 10, 15, 16 From a behavioral perspective, high rates of postpartum relapse are surprising because most women quit early in pregnancy and maintain quitting until delivery; therefore, they have maintained quit status for a significant length of time.15 Susceptibility to relapse after delivery appears to be more
References (24)
- et al.
Women who stop smoking spontaneously prior to prenatal care and predictors of relapse before delivery
Addict Behav
(1991) - et al.
Predictors of smoking during and after pregnancya survey of mothers of newborns
Prev Med
(1995) - et al.
Reducing maternal smoking and relapselong-term evaluation of a pediatric intervention
Prev Med
(1997) - et al.
The role of childbirth in smoking cessation
Prev Med
(1993) - et al.
The impact of pregnancy on women’s prenatal and postpartum smoking behavior
Am J Prev Med
(1992) - et al.
Smoking cessation interventions for pregnant womenreview and future directions
Semin Perinatol
(1995) - et al.
Postpartum smoking relapse
Addict Behav
(1990) - et al.
Pregnancy smoking cessationa case of mistaken identity
Addict Behav
(1996) - et al.
Smoking before, during, and after pregnancy
Am J Public Health
(1990) - et al.
Smoking during pregnancyprevalence, effects, and intervention strategies
Birth
(1991)
Smoking among low-income, pregnant womenprevalence rates, cessation interventions, and clinical implications
Birth
Smoking reduction during pregnancy by a program of self-help and clinical support
Obstet Gynecol
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The PRAMS Working Group is composed of the following individuals from states with PRAMS programs: Alabama, Albert Woolbright; Alaska, Kathy Perham-Hester; Arkansas, Gina Redford; Colorado, Marilyn Leff; Florida, Richard Hopkins; Georgia, Tonya Johnson; Illinois, Bruce Steiner; Louisiana, Danielle Broussard; Maine, Martha Henson; New Mexico, Susan Nalder; New York, Michael Medvesky; North Carolina, Paul Buescher; Ohio, Jo Bouchard; Oklahoma, Richard Lorenz; South Carolina, Alexandra Connelly; Utah, Nan Streeter; Washington, Sherilyn Casey; and West Virginia, Melissa Baker.