Skip to main content

Advertisement

SpringerLink
Log in

Identifying Women at-Risk for Smoking Resumption after Pregnancy

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

While prevalence of smoking during pregnancy has declined over the past two decades, maintenance of cessation after pregnancy remains an important public health challenge, particularly for women of color. This article reports on methods for improving detection of women at risk for smoking resumption after pregnancy through the use of an evidence-based smoking assessment instrument. The instrument was adapted for use by lay health workers in a community-based maternal and infant health program. A total of 276 primarily low-income Black and Hispanic pregnant and postnatal women enrolled in the program were screened for tobacco use in an initial assessment. Of these, 190 were reassessed an average of 2.7 months later. Assessments included measures of current and past smoking and risk factors associated with relapse. Bivariate differences by smoking status were analyzed. Seventeen percent of participants who would be classified as non-smokers using less sensitive screening questions were identified as former smokers and at-risk for resuming smoking. Twenty-two percent of former smokers resumed smoking by reassessment. Smoking resumption among former smokers was associated with having a partner and household members who smoked. Identification of former smokers is critical in order to prevent resumption of smoking after pregnancy and promote long-term maternal smoking cessation. Brief assessment instruments administered at multiple points in time during the prenatal and postnatal periods are an effective means of improving detection of women at risk for smoking resumption. Former smokers should be included in prenatal and postnatal tobacco education and counseling services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. US Department of Health, Human Services. (2001). Women and smoking: A report of the surgeon general. Rockville, MD: US Department of Health and Human Services.

    Google Scholar 

  2. DiClemente, C. C., Dolan-Mullen, P., & Windsor, R. A. (2000). The process of pregnancy smoking cessation: Implications for interventions. Tobacco Control, 9(Suppl 3), iii16–iii21.

    PubMed  Google Scholar 

  3. Fang, W. L., Goldstein, A. O., Butzen, A. Y., et al. (2004). Smoking cessation in pregnancy: A review of postpartum relapse prevention strategies. The Journal of the American Board of Family Practice, 17(4), 264–275.

    Article  PubMed  Google Scholar 

  4. Floyd, R. L., Rimer, B. K., Giovino, G. A., et al. (1993). A review of smoking in pregnancy: Effects on pregnancy outcomes and cessation efforts. Annual Review of Public Health, 14, 379–411.

    Article  CAS  PubMed  Google Scholar 

  5. Dolan-Mullen, P. (2004). How can more smoking suspension during pregnancy become lifelong abstinence? Lessons learned about predictors, interventions, and gaps in our accumulated knowledge. Nicotine and Tobacco Research, 6(Suppl 2), s217–s238.

    Article  Google Scholar 

  6. Orleans, C. T., Barker, D. C., Kaufman, N., et al. (2000). Helping pregnant smokers quit: Meeting the challenge in the next decade. Tobacco Control, 9(Suppl 3), iii6–iii11.

    PubMed  Google Scholar 

  7. Solomon, L. J., & Quinn, V. P. (2004). Spontaneous quitting: self initiated smoking cessation in early pregnancy. Nicotine and Tobacco Research, 6(Suppl 2), s203–s216.

    Article  PubMed  Google Scholar 

  8. Stotts, A., DiClemente, C. C., Carbonari, J. P., et al. (2000). Postpartum return to smoking: Staging a “suspended” behavior. Health Psychology, 19(4), 324–332.

    Article  CAS  PubMed  Google Scholar 

  9. Melvin, C. L., & Tucker, P. (2000). Measurement and definition for smoking cessation intervention research: The Smoke-Free Families experience. Smoke-Free Families common evaluation measures for pregnancy and smoking cessation projects working group. Tobacco Control, 9(Suppl 3), iii87–iii90.

    PubMed  Google Scholar 

  10. Mullen, P. D., Carbonari, J., Tabek, E., et al. (1991). Improving the disclosure of smoking by pregnant women. American Journal of Obstetrics and Gynecology, 165, 409–413.

    CAS  PubMed  Google Scholar 

  11. Croghan, I. T., O’Hara, M. R., Schroeder, D. R., et al. (2001). A community-wide smoking cessation program: Quit and win 1998 in Olmsted County. Preventive Medicine, 33(4), 229–238.

    Article  CAS  PubMed  Google Scholar 

  12. Mullen, P. D., Richardson, M. A., Quinn, V. P., et al. (1997). Postpartum return to smoking: Who is at risk and when. American Journal of Health Promotion, 11(5), 323–330.

    CAS  PubMed  Google Scholar 

  13. Severson, H. H., Andrews, J. A., Lichtenstein, E., et al. (1997). Reducing maternal smoking and relapse: Long-term evaluation of a pediatric intervention. Preventive Medicine, 26(1), 120–130.

    Article  CAS  PubMed  Google Scholar 

  14. Van’t Hof, S. M., Wall, M. A., Dowler, D. W., et al. (2000). Randomised controlled trial of a postpartum relapse prevention intervention. Tobacco Control, 9(Suppl 3), iii64–iii66.

    PubMed  Google Scholar 

  15. Hovell, M., Zakarian, J., Matt, G., et al. (2000). Decreasing environmental tobacco smoke exposure among low income children: Preliminary findings. Tobacco Control, 9(Suppl 3), iii70–iii71.

    PubMed  Google Scholar 

  16. O’Campo, P., Faden, R. R., Brown, H., et al. (1992). The impact of pregnancy on women’s prenatal and postpartum smoking behavior. American Journal of Preventive Medicine, 8(1), 8–13.

    PubMed  Google Scholar 

  17. Melvin, C. L., & Gaffney, C. (2004). Treating nicotine use and dependence of pregnant and parenting smokers: An update. Nicotine and Tobacco Research, 6(Suppl 2), s107–s124.

    Article  CAS  PubMed  Google Scholar 

  18. Hymowitz, N., Schwab, M., McNerney, C., et al. (2003). Postpartum relapse to cigarette smoking in inner city women. Journal of the National Medical Association, 95(6), 461–474.

    PubMed  Google Scholar 

  19. Centers for Disease Control and Prevention. (2001). Surgeon general’s report—women, smoking: Efforts to reduce tobacco use among women and girls. Atlanta, GA: Centers for Disease Control and Prevention.

    Google Scholar 

  20. King, T., Borrelli, B., Black, C., et al. (1997). Minority women and tobacco: Implications for smoking cessation interventions. Annals of Behavioral Medicine, 19(3), 301–313.

    Article  CAS  PubMed  Google Scholar 

  21. Glasgow, R. E., Whitlock, E. P., Eakin, E. G., et al. (2000). A brief smoking cessation intervention for women in low-income Planned Parenthood clinics. American Journal of Public Health, 90(5), 786–789.

    Article  CAS  PubMed  Google Scholar 

  22. Health Resources and Services Administration. Maternal and Child Health Bureau, Division of Healthy Start and Perinatal Services. http://mchb.hrsa.gov/about/dhsps.htm. Last accessed June 5, 2009.

  23. Fiore, M. C., Bailey, W., Cohen, S., et al. (2000). Treating tobacco use and dependence. Rockville, MD: US Department of Health and Human Services. Public Health Service.

    Google Scholar 

  24. English, K., Merzel, C., Moon-Howard, J. Translating public health knowledge into practice: Development of a lay health advisor perinatal tobacco cessation program. Journal of Public Health Management and Practice (Forthcoming).

  25. Pickett, K., Waskschlag, L., & Leventhal, B. (2001). Maternal smoking during pregnancy: Not a stable phenomenon. Paediatric and Perinatal Epidemiology, 15, A27.

    Article  Google Scholar 

  26. Stotts, A., DiClemente, C. C., Carbonari, J. P., et al. (1996). Pregnancy smoking cessation: A case of mistaken identity. Addictive Behaviors, 21(4), 459–471.

    Article  CAS  PubMed  Google Scholar 

  27. Bottorff, J. L., Johnson, J. L., Irwin, L. G., et al. (2000). Narratives of smoking relapse: The stories of postpartum women. Research in Nursing and Health, 23(2), 126–134.

    Article  CAS  PubMed  Google Scholar 

  28. Dunn, C. L., Pirie, P. L., & Lando, H. A. (1998). Attitudes and perceptions related to smoking among pregnant and postpartum women in a low-income, multiethnic setting. American Journal of Health Promotion, 12(4), 267–274.

    CAS  PubMed  Google Scholar 

  29. Edwards, N., & Sims-Jones, N. (1998). Smoking and smoking relapse during pregnancy and postpartum: Results of a qualitative study. Birth, 25(2), 94–100.

    Article  CAS  PubMed  Google Scholar 

  30. Lacey, L., Manfredi, C., Balch, G., et al. (1993). Social support in smoking cessation among black women in Chicago public housing. Public Health Reports, 108(3), 387–394.

    CAS  PubMed  Google Scholar 

  31. Letourneau, A., Batten, S., Mazure, C., et al. (2007). Timing and predictors of postpartum return to smoking in a group of inner-city women: An exploratory pilot study. Birth, 34(3), 245–252.

    Article  PubMed  Google Scholar 

  32. Klerman, L. V., Spivey, C., & Raykovich, K. T. (2000). Smoking reduction activities in a federal program to reduce infant mortality among high risk women. Tobacco Control, 9(Suppl 3), iii51–iii55.

    PubMed  Google Scholar 

  33. Cinciripini, P. M., McClure, J. B., Wetter, D. W., et al. (2000). An evaluation of videotaped vignettes for smoking cessation and relapse prevention during pregnancy: The very important pregnant smokers (VIPS) program. Tobacco Control, 9(Suppl 3), iii61–iii63.

    PubMed  Google Scholar 

  34. Dolan-Mullen, P., Quinn, V. P., & Ershoff, D. H. (1990). Maintenance of nonsmoking postpartum by women who stopped smoking during pregnancy. American Journal of Public Health, 80(8), 992–994.

    Article  Google Scholar 

  35. Hajek, P., & Stead, L. F. (2005). Relapse prevention interventions for smoking cessation. Cochrane Database Systematic Review, 1, CD003999.

    Google Scholar 

  36. McBride, C. M., Curry, S. J., Lando, H. A., et al. (1999). Prevention of relapse in women who quit smoking during pregnancy. American Journal of Public Health, 89(5), 706–711.

    Article  CAS  PubMed  Google Scholar 

  37. Secker-Walker, R. H., Solomon, L. J., Flynn, B. S., et al. (1995). Smoking relapse prevention counseling during prenatal and early postnatal care. American Journal of Preventive Medicine, 11(2), 86–93.

    CAS  PubMed  Google Scholar 

  38. Secker-Walker, R. H., Solomon, L. J., Flynn, B. S., et al. (1994). Individualized smoking cessation counseling during prenatal and early postnatal care. American Journal of Obstetrics and Gynecology, 171(5), 1347–1355.

    CAS  PubMed  Google Scholar 

  39. Secker-Walker, R. H., Solomon, L. J., Flynn, B. S., et al. (1998). Smoking relapse prevention during pregnancy. A trial of coordinated advice from physicians and individual counseling. American Journal of Preventive Medicine, 15(1), 25–31.

    Article  CAS  PubMed  Google Scholar 

  40. Zapka, J. G., Pbert, L., Stoddard, A. M., et al. (2000). Smoking cessation counseling with pregnant and postpartum women: A survey of community health center providers. American Journal of Public Health, 90(1), 78–84.

    Article  CAS  PubMed  Google Scholar 

  41. Fisher, E. B., Auslander, W. F., Munro, J. F., et al. (1998). Neighbors for a smoke free north side: Evaluation of a community organization approach to promoting smoking cessation among African Americans. American Journal of Public Health, 88(11), 1658–1663.

    Article  CAS  PubMed  Google Scholar 

  42. McAlister, A., Morrison, T., Hu, S., et al. (2004). Media and community campaign effects on adult tobacco use in Texas. Journal of Health Communication, 9(2), 95–109.

    Article  PubMed  Google Scholar 

  43. Pirie, P., Rooney, B., Pechacek, T., et al. (1997). Incorporating social support into a community-wide smoking cessation contest. Addictive Behaviors, 22(1), 131–137.

    Article  CAS  PubMed  Google Scholar 

  44. Secker-Walker, R. H., Flynn, B. S., Solomon, L. J., et al. (2000). Helping women quit smoking: Results of a community intervention program. American Journal of Public Health, 90(6), 940–946.

    Article  CAS  PubMed  Google Scholar 

  45. Kahn, R., Certain, L., & Whitaker, R. (2002). A reexamination of smoking before, during, and after pregnancy. American Journal of Public Health, 92(11), 1801–1808.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported in part by project H49MC00133 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. The authors wish to thank and acknowledge the staff of the Downstate New York Healthy Start community partner agencies for their enthusiasm in implementing the smoking cessation initiative and their continued commitment to meeting the needs of women in their communities.

Author information

Authors and Affiliations

  1. Lehman College and the Graduate Center, The City University of New York, New York, USA

    Cheryl Merzel

  2. Columbia University Mailman School of Public Health, New York, USA

    Kevin English & Joyce Moon-Howard

  3. Department of Health Sciences, Lehman College, Gillet Room 417, 250 Bedford Park Blvd. West, Bronx, NY, 10468, USA

    Cheryl Merzel

Authors
  1. Cheryl Merzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin English
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joyce Moon-Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cheryl Merzel.

Appendix

Appendix

Smoking Assessment Instruments

PRENATAL Tobacco Use Initial Assessment

  1. 1.

    In the 3 months before you got pregnant, how many cigarettes or packs of cigarettes did you smoke on an average day? (A pack is 20 cigarettes)

    • _____ # of cigarettes (1 pack = 20 cigarettes)

  2. 2.

    Which best describes you now?

    1. a.

      I smoke regularly now–about the same amount as BEFORE I found out I was pregnant.

    2. b.

      I smoke regularly now, but more than BEFORE I found out I was pregnant.

    3. c.

      I smoke some now, but I have cut down SINCE I got pregnant.

    4. d.

      I stopped smoking AFTER I found out I was pregnant, and I am not smoking now.

    5. e.

      I stopped smoking BEFORE I found out I was pregnant, and I am not smoking now.

    6. f.

      I have NEVER smoked more than 100 cigarettes. (If response is F, skip to #4)

    7. g.

      I have NEVER smoked cigarettes in my lifetime. (If response if G, skip to #4)

  3. 3.

    Have you had a cigarette, even a puff, within the last 7 days?

figure a
  1. 4.

    Does your partner/spouse currently smoke?

figure b
  1. 5.

    Does any one (else) living in your household smoke inside your home?

figure c
  1. 6.

    Which of the following statements best describes the rules about smoking inside your home during your pregnancy? Circle one answer.

    1. a.

      No one is allowed to smoke anywhere inside my home.

    2. b.

      Smoking is allowed in some rooms or at some times.

    3. c.

      Smoking is permitted anywhere inside my home.

POSTNATAL Tobacco Use Initial Assessment

  1. 1.

    In the 3 months before you got pregnant, how many cigarettes or packs of cigarettes did you smoke on an average day? (A pack is 20 cigarettes)

    • _____ # of cigarettes (1 pack = 20 cigarettes)

  2. 2.

    Which best describes you now?

    1. a.

      I smoke regularly now–about the same amount as BEFORE I found out I was pregnant.

    2. b.

      I smoke regularly now, but more than BEFORE I found out I was pregnant.

    3. c.

      I smoke some now, but I have cut down SINCE I got pregnant.

    4. d.

      I stopped smoking AFTER I found out I was pregnant, and I am not smoking now.

    5. e.

      I stopped smoking BEFORE I found out I was pregnant, and I am not smoking now.

    6. f.

      I have NEVER smoked more than 100 cigarettes. (If response is F, skip to #4)

    7. g.

      I have NEVER smoked cigarettes in my lifetime. (If response if G, skip to #4)

  3. 3.

    Have you had a cigarette, even a puff, within the last 7 days?

figure d
  1. 4.

    Does your partner/spouse currently smoke?

figure e
  1. 5.

    Does any one (else) living in your household smoke inside your home?

figure f
  1. 6.

    Is your child exposed to cigarette smoke at least one time a week from anyone other than you or your spouse/partner, i.e., stepparents, grandparents, siblings, friends, day care providers, etc.?

figure g
  1. 7.

    Which of the following statements best describes the rules about smoking inside your home? Circle one answer.

    1. a.

      No one is allowed to smoke anywhere inside my home.

    2. b.

      Smoking is allowed in some rooms or at some times.

    3. c.

      Smoking is permitted anywhere inside my home.

Follow-up Visit Tobacco Use Assessment

  1. 1.

    Have you had a cigarette, even a puff, since our last home visit/telephone call?

figure h
  1. 2.

    Does your partner/spouse currently smoke?

figure i
  1. 3.

    Does any one (else) living in your household smoke inside your home?

figure j
  1. 4.

    (Ask women with any children) Is your child(ren) exposed to cigarette smoke at least one time a week from anyone other than you or your spouse/partner, i.e., stepparents, grandparents, siblings, friends, day care providers, etc.?

figure k
  1. 5.

    Which of the following statements best describes the rules about smoking inside your home? Circle one answer.

    1. a.

      No one is allowed to smoke anywhere inside my home.

    2. b.

      Smoking is allowed in some rooms or at some times.

    3. c.

      Smoking is permitted anywhere inside my home.

All forms adapted from Melvin CL and Tucker P. (2000). Measurement and definition for smoking cessation intervention research: The Smoke Free Families experience. Tobacco Control. 9(Suppl. 3): iii87–iii90, and Melvin CL and Gaffney CA (2003). Treating nicotine use and dependence of pregnant and parenting smokers: An update. Nicotine & Tobacco Research. 6(Suppl. 2): S107–S124.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Merzel, C., English, K. & Moon-Howard, J. Identifying Women at-Risk for Smoking Resumption after Pregnancy. Matern Child Health J 14, 600–611 (2010). https://doi.org/10.1007/s10995-009-0502-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-009-0502-1

Keywords

Search

Navigation