title: Smoking relapse prevention during pregnancy. A trial of coordinated advice from physicians and individual counseling.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Office of Health Promotion Research, University of Vermont, Burlington, Vermont 05401-3444, USA. rseckerw@zoo.uvm.edu
authors.forename: R H
authors.initials: RH
authors.lastname: Secker-Walker
authors.forename: L J
authors.initials: LJ
authors.lastname: Solomon
authors.forename: B S
authors.initials: BS
authors.lastname: Flynn
authors.forename: J M
authors.initials: JM
authors.lastname: Skelly
authors.forename: P B
authors.initials: PB
authors.lastname: Mead
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods / Q000592:standards; D015397:Program Evaluation; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards; D055502:Secondary Prevention; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D016896:Treatment Outcome