Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Abstracts In Press
    • Archives
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Abstracts In Press
    • Archives
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM on Bluesky
  • JABFM On Facebook
  • JABFM On Twitter
  • JABFM On YouTube
Review ArticleClinical Review

Smoking Cessation in Pregnancy: A Review of Postpartum Relapse Prevention Strategies

Wei Li Fang, Adam O. Goldstein, Anne Y. Butzen, S. Allison Hartsock, Katherine E. Hartmann, Margaret Helton and Jacob A. Lohr
The Journal of the American Board of Family Practice July 2004, 17 (4) 264-275; DOI: https://doi.org/10.3122/jabfm.17.4.264
Wei Li Fang
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Adam O. Goldstein
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anne Y. Butzen
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
S. Allison Hartsock
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Katherine E. Hartmann
MD, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Margaret Helton
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jacob A. Lohr
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Figure 1.
    • Download figure
    • Open in new tab
    Figure 1.

    Pregnancy and postpartum smoking relapse prevention.

Tables

  • Figures
    • View popup
    Table 1.

    Factors Related to Smoking Cessation and Relapse in Pregnancy

    Factors Influencing Pregnant Women to QuitFactors That Trigger Postpartum Women to Smoke Again
    Pregnancy Related
     Planned pregnancyEntering postpartum
     Morning sicknessStress of caring for a newborn
     Becoming visibly pregnantWeaning from breast-feeding
     Decision to breast-feed
    Social Reasons
     Social pressuresPartners who smoke
     GuiltSocial pressures
     Social supportFamiliar cues such as drinking alcohol or coffee/tea, after meals, on the phone, in the car, etc.
    Exposure to high-risk situations
    General Health of Self and Others
     Baby’s healthNeed time for self
     Children with asthma or other respiratory problemsUnder pressure from children
     Personal health reasonsTrying to relax
    Feeling sad and irritable
    Weight gain
    Clinical Interventions
     Participation in a cessation program
     Advice from a physician or other health care provider
    • View popup
    Table 2.

    Programs that Focus on Postpartum Smoking Relapse Prevention

    StudyInterventionPopulation StudiedNo. of ParticipantsOutcomeResultsComments/ Recommendations
    44Examine experiences of smoking relapse among postpartum women using narrative research.Women who stopped smoking during pregnancy; Canada.27Experience due to postpartum cessation relapse.Five general story lines were identified: (1) controlling one’s smoking (starting with one puff/constricting amount smoked); (2) vulnerable to smoking (inability to resist); (3) nostalgia for former self (freedom and happier times); (4) smoking for relief (manage emotions and stress); (5) never really having quit (did not want to quit for themselves).Relapse among postpartum women is unique and requires specialized intervention.
    45Study examines the prevalence and intensity of smoking before, during and after pregnancy, and identifies correlates of postpartum smoking relapse.Women in 10 states who had delivered live births.17,378Smoking behavior and correlates.25.6% of women smoked before pregnancy. Of those, 44.5% quit during pregnancy, half of whom relapsed at time of survey (2 to 6 months postpartum).Increased risk of postpartum: African American race, multiparity, late or no prenatal care, high maternal weight gain, stressful life events.
    46Study to gain insight into attitudes and perceptions about smoking during pregnancy, passive smoke exposure, barriers to quitting, and program preferences.Nine focus group discussions were conducted with multiethnic, low-income mothers.57Attitudes and perceptions about smoking during pregnancy, passive smoke exposure, barriers to quitting, and program preferences.Personal barriers to quitting included being around others who smoked, feelings of stress and boredom, addiction, and not believing smoking is dangerous enough. Participants tended to value pregnancy-related advice from female friends and relatives over advice from professionals.Educational efforts are effective when directed at networks of women who share information.
    18Study comparing the rates of continuous smoking abstinence, daily smoking, and smoking cessation self-efficacy in treatment and control groups. Nurses provided counseling at birth and telephone counseling.Pregnant women who quit smoking during pregnancy; Canada.254Postpartum cessation relapse.6 months abstinence rate in treatment was 38% and 27% in the control. 48% of control vs 34% treatment smoked daily. Smoking cessation efficacy did not vary between groups.Interventions can be strengthened if they are extended to the postpartum period.
    47Comparison study between two pre- and postnatal programs offered to pregnant smokers, HOPP (Healthy Options for Pregnancy and Parenting) offered telephone counseling; STORK (Stop Tobacco for OuR Kids) offered cessation counseling by staff during pre- and postpartum and well-baby visits.Pregnant women who smoke in managed care settings, Minnesota.2 postnatal programs.Program implementation and efficacy.97% of HOPP participants reported receiving calls; relapse rates delayed but not prevented. Problems with identification of target population and acceptance of repeated calls. 91% of STORK participants reported receiving the intervention in year 1, but delivery declined. Relapse was not significantly reduced at the 12-month mark.A combined intervention that incorporates elements of both HOPP and STORK would be optimal if it could be implemented at reasonable cost.
    11Three groups: control received a self-help booklet only, a prepartum relapse prevention, or prepartum and postpartum relapse prevention. Postpartum relapse measured.Pregnant smokers at 2 managed care organizations, Washington.897 (457 in Seattle and 440 in Minnesota).Postpartum abstinence rates.Pre/post intervention delayed but did not prevent postpartum relapse to smoking. Prevention abstinence was significantly greater for pre/post intervention group at 8 weeks (booklet, 30%; prepartum, 35%; pre/post group, 39%) and at 6 months (booklet, 26%; prepartum, 24%; pre/post group, 33%)Evaluation of relapse prevention interventions for smokers who quit during pregnancy reveals relapse prevention interventions need to be increased in duration and potency to prevent postpartum relapse.
    4Examine the association between early weaning and smoking relapse.Women who stopped smoking during pregnancy; Canada.228Postpartum cessation relapse and early weaning.65% of women who relapsed to daily smoking weaned before 26 weeks (early weaning) vs 34% who remained abstinent or smoked occasionally. Women who resumed daily smoking were almost 4 times more likely to wean early than those who abstained or smoked occasionally.Smoking relapse prevention in the postpartum period is one of the most effective interventions in ensuring that women who stop smoking for pregnancy remain stopped and breast-feed their babies for the recommended duration.
    56Study examined long-term effectiveness of postpartum relapse prevention intervention by evaluating the smoking status and cessation self-efficacy of original study participants at 12 months after delivery.Women who participated in Johnson, 2000 study; Canada.238Postpartum cessation relapse.12-month abstinence: 21% treatment and 18.5% control; smoking daily: 41% treatment and 50% control; treatment attained higher self-efficacy.Four variables associated with relapse to daily smoking are: breast-feeding and mental health had protective effects, and partners who smoked and greater amount smoked before pregnancy had adverse effects.
    14Examine the efficacy of physicians’ advice and referral to individual counseling in preventing cessation relapse.Women who quit before first prenatal visit; Vermont.414 (188 in intervention and 226 in usual care group).Postpartum cessation relapse.No significant differences between intervention and usual care groups during pregnancy or 1 year postpartum (23%; 32% vs 22%).Referral to individual relapse counseling did not have a significant impact; however, the level of attention paid to smoking by physicians has contributed to overall lower relapse rates. Physicians could benefit from training on how to gain a pregnant smokers’ commitment to change her smoking behavior, an office prompt system, and individualized smoking behavior change counseling.
    50Participants were classified as PC (precontemplation), C (contemplation), PA (preparation), or A (action) after being assessed for personal goals, self-efficacy, and smoking behavior. Group differences in smoking were assessed at 6 weeks and 3, 6, and 12 months postpartum.Pregnant women who quit smoking during pregnancy; Texas.256.Postpartum cessation relapse.Percentage of women who returned to postpartum smoking was highest in the precontemplation stage and decreased with each subsequent stage (6 weeks, 83% of PCs, 64% of Cs, 35% of PAs, and 24% of As had relapsed).Stage-based interventions should be developed to assist women in maintaining postpartum abstinence.
    51Test the effects of low-intensity, smoking cessation/ relapse prevention intervention delivered by clinicians based on stages-of-change and motivational interviewing techniques.Pregnant women who quit smoking during pregnancy; Oregon.3,907 (historical comparison of 1028, interim comparison of 824, and intervention group of 2055).Pre and postpartum relapseSelf-reported quit rates were significantly higher in treatment group for quit rates and sustained abstinence rates at 6 and 12 months.An intervention that supports women who want to quit smoking during pregnancy should be offered. It will also increase the likelihood for a woman to stay smoke-free after delivery.
    52Women received 15 to 30 minutes relapse prevention from nurse; included counseling about reasons for maintaining cessation and developing a plan. Pediatricians were given women’s smoking history and brief tips on cessation counseling. At the 2-week, 2-month, and 4-month well-baby visits with pediatrician, women received reinforcement and encouragement to try to (stay) quit.Women just delivered at area hospitals and who smoked in the last 30+ days before pregnancy and quitting during pregnancy, predominantly white, Oregon.287 (141 experimental, 146 control).Abstinence rates during pregnancy and postpartum.No difference in the relapse rates of women in the intervention and control. Moderate association between confidence to stay quit and nonrelapse. No significant association between experimental and control group between days until relapse, time before 1st cigarette in the morning, number of quit attempts since delivery, number of cigarettes smoked each day. Effective at getting providers to offer intervention, but intervention itself was not effectiveRelapse prevention should (1) be added to cessation interventions; (2) include messages aimed at bolstering confidence in staying quit; (3) be delivered during prenatal, postpartum, and early childhood care; and (4) presented to a woman and her social network by ancillary staff.
    53Study assessed providers’ performance of smoking cessation counseling steps with low-income pregnant and postpartum women receiving care at community health centers.WIC program staff, obstetric and pediatric clinicians at community health clinics; Massachusetts.6 centers; 177 clinical staff members.Smoking intervention practices (performance), knowledge and attitudes, and organizational facilitators.Performance scores differed significantly by clinic and provider type. Providers in obstetric clinics had the highest scores and those in pediatric clinics had the lowest scores. Nurse practitioners and nutritionists had higher scores than other providers. Clinic type, greater smoking-related knowledge, older age, and perception of smoking cessation as a priority were independently related to better counseling performance.Mean performance scores demonstrated room for improvement in all groups. Low scores for performance of steps beyond assessment and advice indicate a need for emphasis on the assistance and follow-up steps of national guidelines. The provider’s own commitment to helping mothers stop smoking was important.
PreviousNext
Back to top

In this issue

The Journal of the American Board of Family Practice: 17 (4)
The Journal of the American Board of Family Practice
Vol. 17, Issue 4
1 Jul 2004
  • Table of Contents
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Smoking Cessation in Pregnancy: A Review of Postpartum Relapse Prevention Strategies
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
2 + 1 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Smoking Cessation in Pregnancy: A Review of Postpartum Relapse Prevention Strategies
Wei Li Fang, Adam O. Goldstein, Anne Y. Butzen, S. Allison Hartsock, Katherine E. Hartmann, Margaret Helton, Jacob A. Lohr
The Journal of the American Board of Family Practice Jul 2004, 17 (4) 264-275; DOI: 10.3122/jabfm.17.4.264

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Smoking Cessation in Pregnancy: A Review of Postpartum Relapse Prevention Strategies
Wei Li Fang, Adam O. Goldstein, Anne Y. Butzen, S. Allison Hartsock, Katherine E. Hartmann, Margaret Helton, Jacob A. Lohr
The Journal of the American Board of Family Practice Jul 2004, 17 (4) 264-275; DOI: 10.3122/jabfm.17.4.264
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Acknowledgments
    • References
  • Figures & Data
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Delivering Interconception Care During Well-Child Visits: An IMPLICIT Network Study
  • Factors across the life course predict womens change in smoking behaviour during pregnancy and in midlife: results from the National Child Development Study
  • Google Scholar

More in this TOC Section

  • Interpretating Normal Values and Reference Ranges for Laboratory Tests
  • Non-Surgical Management of Urinary Incontinence
  • Screening and Diagnosis of Type 2 Diabetes in Sickle Cell Disease
Show more Clinical Review

Similar Articles

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2025 American Board of Family Medicine

Powered by HighWire