title: Postpartum return to smoking: who is at risk and when.
abstract: OBJECTIVE
  Despite high rates of spontaneous and assisted smoking cessation during pregnancy, postpartum maintenance is disappointingly low. Predictors of return to smoking remain unclear, thus limiting the development of interventions that could protect the health of women and their children. This study followed women who had participated in a prenatal smoking cessation intervention trial and successfully stopped smoking to address two aims: (1) describe the probability of relapse in confirmed quitters during the first 6 months after the birth, and (2) identify factors that increase relapse.
  
  
  METHODS
  Prospective design during pregnancy and retrospective report at 6 months postpartum used survival analysis with return to smoking as the dependent variable and the Cox proportional hazards regression technique.
  
  
  METHODS
  Questionnaires were used at the first prenatal visit and telephone interviews at the 26th week of pregnancy and 6 months postpartum. Nonsmoking after the 20th week was measured by urine cotinine tests (m = 3); nonsmoking postpartum was measured by retrospective self-report.
  
  
  METHODS
  The setting was an HMO-based group practice in Los Angeles.
  
  
  METHODS
  Subjects were white, black, and Hispanic women (n = 127) available for follow-up.
  
  
  RESULTS
  The proportion of the sample classified as relapsers at 6 months postpartum was 62.9%. The final model identified the following risk factors for smoking: taking puffs in late pregnancy and having friends who smoke at the first prenatal visit, less confidence in mid-pregnancy that they could maintain nonsmoking postpartum, and a partner who smokes postpartum.
  
  
  CONCLUSIONS
  Intervention should begin in late pregnancy, and smoking networks, including partner smoking, should be addressed.
authors.affiliation: Center for Health Promotion Research and Development, School of Public Health, University of Texas-Houston Health Science Center, USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Mullen
authors.forename: M A
authors.initials: MA
authors.lastname: Richardson
authors.forename: V P
authors.initials: VP
authors.lastname: Quinn
authors.forename: D H
authors.initials: DH
authors.lastname: Ershoff
mesh_terms: D000704:Analysis of Variance; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011295:Prenatal Care; D016016:Proportional Hazards Models; D012307:Risk Factors; D016540:Smoking Cessation / Q000523:psychology; D016019:Survival Analysis