Smoking during pregnancy and postpartum has tremendous implications for lung disease and early development of lung function. Smoking cessation among pregnant women reduces adverse health effects. Postpartum maintenance of nonsmoking further reduces the risks of premature morbidity and mortality from lung and other diseases in women, and, in children, the risks of respiratory Illness and alterations In lung development from exposure to passive smoke. The proposed study addresses the problem of high rates of postpartum relapse after sustained abstinence from smoking during pregnancy. We propose a randomized trial to address 2 questions: (1) will state-of-the-art relapse prevention strategies reduce postpartum relapse rates compared to currently available self-help materials for pregnant smokers; and (2) is additional relapse prevention intervention necessary in early postpartum to maintain long term smoking cessation? The proposed study tests the Impact of cognitive-behavior relapse prevention strategies targeted to pregnancy and postpartum as adjuncts to state-of-the-art self-help smoking cessation programs. The relapse prevention Interventions focus on enhancing motivation, use of coping strategies and situation specific self-efficacy late in pregnancy and early postpartum, a high risk time for relapse. The intervention components will be delivered via written personalized feedback, telephone counseling and newsletters. The research will be conducted in two large medical settings: Group Health Cooperative of Puget Sound and Park Nicollet of Minneapolis. At each site, telephone interviews will be conducted with all women scheduled for their first prenatal visit to screen for eligibility and collect baseline measures from eligible women. Pregnant smokers and those who quit smoking less than or equal to 1 month prior to pregnancy determination (N = 900; 450 per site) will be randomized to one of three treatment conditions: (1) self-help materials only, (2) self-help + prepartum relapse prevention, and (3) self-help + pre- and postpartum relapse prevention. Followup telephone interviews will be conducted at: 24 weeks of pregnancy; 6 weeks, 6 months and 16 months postpartum. Data will be obtained on smoking status, motivation, self efficacy, relapse situations, use of coping strategies, and appraisal of other intervention components at each follow-up. The feasibility of providing feedback concerning levels of household environmental tobacco smoke (ETS) and its impact on maintenance of nonsmoking will be assessed in an additional 200 pregnant smokers (100 per site). The long term goal of the project is to provide a relapse prevention intervention which is theory based, highly portable, and easily disseminable that can be integrated as part of routine prenatal care.
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