Predictors of Smoking Cessation in Pregnancy and Maintenance Postpartum in Low-Income Women
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Objective: To describe factors associated with smoking status of low-income women during pregnancy and postpartum. Methods: Data from a randomized clinical trial were used to conduct separate analyses on 327 women who smoked at baseline (time at enrollment) and for whom smoking status was available at delivery, and on 109 women who reported not smoking at delivery (quit spontaneously or after study enrollment) and for whom smoking status was available at 6-months postpartum. Salivary cotinine was used to assess the accuracy of self-reported smoking status for the sample as a whole. Data were collected between May 1997 and November 2000. Results: 18% of the 327 baseline smokers stopped smoking before delivery. Cessation was less likely in older women, those reporting Medicaid coverage (vs. commercial or no insurance), who were at a later week of pregnancy at baseline, were more addicted, had a husband/partner who smoked, and did not receive the study intervention. 37% of the 109 women who reported not smoking at delivery maintained abstinence at 6-months postpartum. Factors associated with abstinence were later week of pregnancy at baseline and quitting spontaneously with pregnancy, while women who lived with a smoker were less likely to report abstinence. Spontaneous quitters were less likely to relapse by 6 months postpartum than women who quit smoking later in pregnancy. Conclusions: Partner participation in smoking cessation programs for pregnant and postpartum women merits exploration. Lower relapse rates among spontaneous quitters indicate a need to foster an environment that encourages quitting at pregnancy.
KEY WORDS:low-income population smoking cessation prenatal care postpartum maintenance
The project described was supported by grant R01-HL51319-03 to Dr. Judith K. Ockene from the National Heart, Lung, and Blood Institute (NHLBI). The study received its initial Institutional Review Board approval in April 1993. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI. The authors wish to thank the Massachusetts WIC office under the leadership of Jan Kallio for its support and the research assistants (Evangelina Alvarez, Jessica Amador, Estenia Parsons, Janet Raphaelson, Nancy Smith) who collected the data. The authors are indebted to the women and the health centers who participated in this study.
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