This 5-year demonstration and education project will design, implement, and evaluate a program that integrates family lung health messages and environmental change to sustain smoking cessation postpartum by women who had stopped smoking in pregnancy. The project builds on our work with pregnant smokers, and it is the next logical step in converting the high rates of assisted and unassisted smoking cessation in pregnancy to permanent abstinence. The TLC Program is unique in its focus on the postpartum period. It will 1) use a researched model of behavior change that matches messages and skill training with the woman's stage of change, 2) address the whole family to create a supportive environment for individual change, 3) include other steps for families to protect children from passive smoke and negative modeling, and 4) focus on smoking and smoke exposure directly as well as through self-care and child-care messages. Innovative materials, including videotapes and intervention. The project will take place in 2 multi-ethnic health-care sites where the research team has conducted previous studies. The study will use a randomized mixed design with 500 women who smoked regularly before pregnancy and who have been abstinent for > 30 days at their 28th week of pregnancy. The primary outcome is abstinence at 1 year postpartum. Secondary outcomes are partner smoking status and exposure of the index baby. Self report will be validated biochemically in samples of mothers and babies. The study design separates data collection from the experiments by enrolling subjects in a university-sponsored study of new mothers' health-care site. The results from this study will 1) demonstrate the effectiveness of a practical program to protect women and their families from direct and indirect smoke exposure and 2) contribute longitudinal data on change processes involved in smoking cessation, especially those over the maintenance, relapse, and recycling stages, in a relatively complete population through a critical transition.
