title: Postpartum Smoking Relapse After Quitting During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2000-2011.
abstract: Relapsing to smoking postpartum jeopardizes a woman's health and her infant's health. Our study estimated the proportion and identified characteristics associated with postpartum relapse using a large population-based sample.
  
  
  
  We analyzed Pregnancy Risk Assessment Monitoring System data among women with live births. Relapse was defined as smoking at survey completion among those who quit by the last 3 months of pregnancy. We assessed linear trends for relapse during 2000-2011 in 40 sites overall and individually using logistic regression. Adjusted prevalence ratios (aPRs) were calculated to assess characteristics associated with relapse during 2009-2011 (n = 13,076).
  
  
  
  During 2000-2011, the proportion of women who relapsed postpartum remained unchanged overall (p = 0.84) and by site (p ≥ 0.05 for each), ranging in 2011 from 30.8% to 52.2% (Wyoming-Arkansas). Characteristics associated with relapse compared with reference groups were prepregnancy daily smoking (aPR = 1.80; 95% confidence interval (CI): 1.59-2.04); age <20 years (aPR = 1.51; 1.24-1.84), 20-24 years (aPR = 1.39; 1.17-1.65), or 25-34 years (aPR = 1.26; 1.07-1.48); not initiating breastfeeding (aPR = 1.34; 1.24-1.44); not having a complete home smoking ban (aPR = 1.27; 1.14-1.42); being black non-Hispanic (aPR = 1.25; 1.14-1.38); being multiparous (aPR = 1.20; 1.11-1.28); experiencing 3-5 stressors during pregnancy (aPR = 1.12; 1.01-1.24); having an unintended pregnancy (aPR = 1.11; 1.03-1.19); and having 12 years of education (aPR = 1.09; 1.01-1.17).
  
  
  
  There was no change in the proportion of women relapsing postpartum during 2000-2011. In 2011, nearly half (42%) of women relapsed after quitting smoking during pregnancy. Disparities exist by site and by maternal characteristics. A comprehensive approach maximizing tobacco control efforts and developing effective clinical interventions delivered across sectors is necessary for long-term tobacco abstinence among women.
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .|2 Oak Ridge Institute for Science and Education, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia .
authors.forename: Karilynn M
authors.initials: KM
authors.lastname: Rockhill
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Van T
authors.initials: VT
authors.lastname: Tong
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Farr
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Robbins
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Denise V
authors.initials: DV
authors.lastname: D'Angelo
authors.affiliation: 3 Office of Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
authors.forename: Lucinda J
authors.initials: LJ
authors.lastname: England
mesh_terms: D000328:Adult; D005006:Ethnicity; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D011159:Population Surveillance / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D013997:Time Factors