Maternal smoking cessation and relapse prevention during health care visits

Background: Although effects of maternal smoking during pregnancy could be alleviated if women quit early in pregnancy, most do not. Relapse rates amo ng quitters are high. Objective: To test the effects of a low-intensity, smoking-cessation/relaps e-prevention intervention delivered by clinic staff and providers and based on stages-of-change constructs of the transtheoretical model and brief mot ivational interviewing techniques. Methods: A quasi-experimental prospective cohort design employed in obstetr ic, in-patient, and pediatric care delivery settings of a large health main tenance organization in Portland, Oregon. Subjects were pregnant smokers re gistered for their first prenatal visit. Primary outcome measures were sust ained (self-reported) quit rates during pregnancy and smoking abstinence be tween 6 and 12 months after delivery. Results: Regression analyses found statistically significant improvement fo r intervention women in sustained pregnancy quit rates (OR=2.7, CI=1.2-5.7) and on smoking abstinence between 6 and 12 months after delivery (OR=2.4, CI=1.1-5.3). Conclusions: While these outcomes are based on self-report only, they emerg ed despite variable delivery of the intervention across clinics and represe nt clinically meaningful improvements in rates of nonsmoking. The intervent ion supports women who want to quit smoking during pregnancy and improves t he likelihood of their remaining nonsmokers for the long term. (C) 2001 Ame rican Journal of Preventive Medicine.