Abstract
Introduction: Our objective was to examine the efficacy of physicians’ advice and
referral to individual counseling in preventing relapse to smoking among women who
were smokers early in pregnancy, but quit prior to their first prenatal visit.
Design: A randomized controlled trial of prompted physician’s advice and individual
relapse prevention counseling during pregnancy compared to usual physician advice.
Smoking status was assessed by self-report, exhaled carbon monoxide, and urinary cotinine
during pregnancy and by self-report 1 year postpartum.
Results: There were no significant differences in relapse rates between the intervention
and usual-care groups during pregnancy, nor at 1 year postpartum. Relapse rates were
23% in both groups at the 36-week visit, and 32% and 22%, respectively, 1 year postpartum.
Younger age, higher motivation to resume smoking, and higher levels of exhaled carbon
monoxide at the first prenatal visit were predictive of relapse to smoking during
pregnancy. With the conservative assumption that all those lost to follow-up relapsed,
the combined 1-year postpartum relapse rate, 51%, was 17 percentage points lower than
we observed in an earlier relapse prevention trial, and 15 percentage points lower
than that observed nationally a decade earlier.
Conclusion: Prompting physicians to provide supportive advice combined with referral
to individual relapse prevention counseling did not reduce smoking relapse rates during
pregnancy, or postpartum. However, the level of attention paid to smoking by physicians
in both intervention and usual-care groups during pregnancy may have contributed to
the relatively low relapse rates seen 1-year postpartum.
Keywords
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© 1998 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
