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Smoking relapse prevention during pregnancy

A trial of coordinated advice from physicians and individual counseling
  • Roger H Secker-Walker
    Correspondence
    Address correspondence to: R. H. Secker-Walker, MB, FRCP, 1 South Prospect Street, Burlington, VT 05401-3444
    Affiliations
    Office of Health Promotion Research (Secker-Walker, Flynn), University of Vermont, Burlington, Vermont USA 05401-3444
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  • Laura J Solomon
    Affiliations
    Department of Psychology (Solomon), University of Vermont, Burlington, Vermont USA 05401-3444

    Department of Vermont Cancer Center (Secker-Walker, Solomon, Flynn), University of Vermont, Burlington, Vermont, USA 05401-3444
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  • Brian S Flynn
    Affiliations
    Office of Health Promotion Research (Secker-Walker, Flynn), University of Vermont, Burlington, Vermont USA 05401-3444

    Department of Family Practice (Flynn), University of Vermont, Burlington, Vermont USA 05401-3444

    Department of Vermont Cancer Center (Secker-Walker, Solomon, Flynn), University of Vermont, Burlington, Vermont, USA 05401-3444
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  • Joan M Skelly
    Affiliations
    Department of Biometry Facility (Skelly), University of Vermont, Burlington, Vermont USA
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  • Philip B Mead
    Affiliations
    Department of Obstetrics and Gynecology (Mead), University of Vermont, Burlington, Vermont USA 05401-3444
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      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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      References

        • Fergusson D.M
        • Horwood L.J
        • Shannon F.T
        Smoking during pregnancy.
        NZ Med J. 1979; 89: 41-43
        • Williamson D.F
        • Serdula M.K
        • Kendrick J.S
        • Binkin N.J
        Comparing the prevalence of smoking in pregnant and nonpregnant women, 1985 to 1986.
        JAMA. 1989; 261: 70-74
        • Floyd R.L
        • Rimer B.K
        • Giovino G.A
        • Mullen P.D
        • Sullivan S.E
        A review of smoking in pregnancy.
        Annu Rev Pub Health. 1993; 14: 379-411
        • Quinn V.P
        • Mullen P.D
        • Ershoff D.H
        Women who stop smoking spontaneously prior to prenatal care and predictors of relapse before delivery.
        Addict Behav. 1991; 16: 29-40
        • Petersen L
        • Handel J
        • Kotch J
        • Podedworney T
        • Rosen A
        Smoking reduction during pregnancy by a program of self-help and clinical support.
        Obstet Gynecol. 1992; 79: 924-930
        • Ershoff D.H
        • Quinn V.P
        • Mullen P.D
        Relapse prevention among women who stop smoking early in pregnancy.
        Am J Prev Med. 1995; 11: 178-184
        • Sexton M
        • Hebel J.R
        • Fox N.L
        Postpartum smoking.
        in: Rosenberg M.J Smoking and reproductive health. PSG Publishing, Littleton, Massachusetts1987: 222-226
        • Secker-Walker R.H
        • Solomon L.J
        • Flynn B.S
        • Skelly J.M
        • Lepage S.S
        • Goodwin G.D
        • Mead P.B
        Smoking relapse prevention counseling during prenatal and early postnatal care.
        Am J Prev Med. 1995; 11: 86-93
        • Secker-Walker R.H
        • Solomon L.J
        • Flynn B.S
        • et al.
        Training obstetric and family practice residents to give smoking cessation advice during prenatal care.
        Am J Obstet Gynecol. 1992; 166: 1356-1363
        • Secker-Walker R.H
        • Flynn B.S
        • Solomon L.J
        • et al.
        Helping women quit smoking.
        Am J Prev Med. 1996; 12: 367-377
        • Haley N.J
        • Axelrad C.M
        • Tilton K.A
        Validation of self-reported smoking behavior.
        Am J Pub Health. 1983; 73: 1204-1207
      1. Secker-Walker RH, Flynn BS, Solomon LJ, Collins-Burris L, Lepage SS, Mead PB. Attitudes, beliefs and other smokers: factors affecting smoking cessation in pregnancy. Presented at the 114th Annual Meeting of the American Public Health Association, Las Vegas, Nevada, October 1986.

      2. Secker-Walker RH, Solomon LJ, Flynn BS, Skelly JM, Mead PB. Reducing smoking in pregnancy and postpartum: physician’s advice supported by individual counseling. Prev Med 1997 (in press).

        • Fingerhut L.A
        • Kleinman J.C
        • Kendrick J.S
        Smoking before, during and after pregnancy.
        Am J Pub Health. 1990; 80: 541-544
        • Prochaska J.O
        • Velcier W.F
        • Rossi J.S
        • et al.
        Stages of change and decisional balance for 12 problem behaviors.
        Health Psychol. 1994; 13: 39-46
        • Curry S.J
        • Marlatt G.A
        • Gordon J
        • Baer J.S
        A comparison of alternative theoretical approaches to smoking cessation and relapse.
        Health Psychol. 1988; 7: 545-556
        • Lichtenstein E
        • Glasgow R.E
        Smoking cessation.
        J Consult Clin Psychol. 1992; 60: 518-527
        • Stevens V.J
        • Hollis J.F
        Preventing smoking relapse using an individually tailored skills training technique.
        J Consult Clin Psychol. 1989; 57: 420-424