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Randomised controlled trial of a postpartum relapse prevention intervention
  1. Susan M Van't Hofa,
  2. Michael A Wallb,
  3. David W Dowlera,
  4. Michael J Starka
  1. aProgram Design and Evaluation Services, Oregon Health Division, Portland, Oregon, USA, bPulmonary Division, Department of Pediatrics, Oregon Health Sciences University, Portland
  1. Susan M Van't Hof, Program Design and Evaluation Services, Oregon Health Division, 800 NE Oregon Street, Suite 550, Portland, OR 97232, USA;susan.m.vanthof{at}

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Many women quit smoking during pregnancy but postnatal relapse rates are high, averaging 50–80% in the first year after delivery.1 2 Previous work suggests that provider based relapse intervention in the context of well-baby visits may lead to a decrease in postnatal relapse rates.3 However, prior research also suggests that the majority of postnatal providers do not take a systematic approach to obtaining a smoking history from all new mothers, and thus may miss opportunities for cessation and relapse counselling.3 4

In the present study we examined whether: (1) a relapse prevention intervention, implemented during the hospital stay during the period soon after delivery and at well-baby visits, would reduce the rate of relapse to smoking six months postpartum; (2) the time of delivery was an opportune moment to obtain a smoking history; (3) the history could be transmitted quickly to the infant's pediatric provider; and (4) transmission would lead to increased rates of relapse advice.


All women delivering babies at six participating Portland, Oregon, metropolitan area hospitals received an in-hospital screening and were deemed eligible for the study if they reported smoking during the 30 days before the pregnancy and quitting during pregnancy, and were willing to speak with a Visiting Nurse Association (VNA) nurse about having quit smoking. Women were not eligible to be screened if there was a maternal or child illness that would prevent them from attending the paediatric well-baby visits; if the baby was being adopted; or if the woman did not speak English.

When an eligible woman agreed to participate in the study, the delivery nurse or the birth certificate clerk contacted the VNA. A VNA nurse informed the woman about the study, obtained informed consent, collected a saliva sample for cotinine verification of non-smoking status, and conducted the baseline assessment …

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