Assisting mothers to quit smoking during and after pregnancy

Researchers at Moffitt Cancer Center, concerned that women who quit smoking during their pregnancies often resume smoking after they deliver their baby, tested self-help interventions designed to prevent postpartum smoking relapse.

“We’d first like to see more women quit smoking when they become pregnant,” said Thomas H. Brandon, Ph.D., senior member at Moffitt and chair of the Department of Health Outcomes and Behavior. “However, even among those who do quit, the majority return to smoking shortly after they give birth.”

According to the researchers, nearly 50 percent of pregnant women who smoke quit during their pregnancies, but relapse rates are estimated at between 50 and 80 percent. Not only is this resumption of smoking harmful for the new mothers, but their babies could also be exposed to dangerous environmental tobacco smoke (ETS).

“More and more women are aware that it is in the best interest of their child to give up alcohol and cigarettes while pregnant,” said Dr. Brandon, the study’s senior author. “But, unfortunately, they don’t realize that exposing their infant to ETS can be equally as harmful.”

Infants exposed to ETS are more likely to suffer from respiratory, die of Sudden Infant Death Syndrome (SIDS), get middle ear infections, have lower IQ’s and more behavioral problems, and to become smokers themselves later in life. Also, a mother who returns to smoking loses the progress she’s made to improve her health and life expectancy.

In an effort to find better ways to prevent smoking relapse in new mothers, the researchers recruited 504 women from around the United States. All were in their fourth to eighth month of pregnancy and had already quit smoking. Half of the women were mailed two existing “usual care” self-help guides about quitting smoking and the dangers of ETS on newborns. The other half were sent a series of ten booklets developed at Moffitt, titled “Forever Free for Baby and Me.” These booklets provided more detailed information about how to stay off cigarettes during and after pregnancy. Additional support information for the mom-to-be’s partner was also included the series.

By eight months after they gave birth, 70 percent of the women who received the “Forever Free” series reported that they remained off cigarettes, compared to 59 percent of those who received the “usual care” booklets.

The researchers reported that the treatment effect depended upon the women’s household income and age. For example, among lower income women earning less than $30,000 per year who received the “Forever Free” intervention, 72 percent were not smoking a year after giving birth, compared to 51 percent for women who received “usual care.” In contrast, women with higher incomes received no additional benefit from the “Forever Free” booklets. The effect of age was similar to income, with younger women showing greater benefit from the “Forever Free” booklets.

“Our booklets were designed to be accessible to a diverse population with respect to content, reading level and graphic design,” said co-author Vani Nath Simmons, Ph.D, an assistant member at Moffitt. “We think that they provided novel information and assistance to these women–information that may have already been available to older and higher-income women.”

The researchers concluded that “Forever Free for Baby and Me,” “a minimal, inexpensive, self-help intervention” has the potential to reach and help pregnant women and new mothers – a particularly challenging subpopulation of smokers.

The study was published online in the American Journal of Public Health.

Source: Moffitt Cancer Center