Table 1.

Postpartum relapse prevention trials

Study	Participants (sample size)a	Design	Intervention components	Intervention providers	Follow-up	Abstinence rates	Correlates of abstinence	Smoking assessment
Peterson et al. (1992)	smokers recruited from prenatal clinics at large HMO (N=224)	randomized clinics to intervention 1 (I1) or intervention 2 (I2)	I1: manual and audiotape with section on pp maintenance I2: manual and tape + staff training + letters signed by physician mailed in 8th month of pg and 1st month pp	I2: obstetricians and nursing staff trained on effects of smoking; no counseling	8 wks	C=57.1% I1=61.3% I2=79.3% (p=0.05 for C vs. I2)	none reported	no
Secker-Walker et al. (1995)	self-reported nonsmokers recruited at first prenatal visit (N=175)	randomized to UC or I	individual counseling about relapse prevention during pregnancy. Final visit (36 wks) addressed pp period.	trained counselors, booklet	8–54 mos	I=33% C=32% (NS)	none reported	self-reportb
Wall et al. (1995)	self-reported smoking within one month of pregnancy at first pediatric visit (N=858)	randomized practices to minimal (I1) or extended intervention (I2)	I1: packet of written materials after delivery I2: packet and interventions during first four well-baby visits	trained pediatricians	6 mos	I1=37% I2=47% (p<0.01)	partner smoking, less education associated with relapse	self-report
Gielen et al. (1997)	self-reported smoking before 28 weeks of pregnancy (N=98)	randomized to I or UC	written guide and brief counseling about relapse prevention	trained peer health counselor	6 mos	I=15% C=4%d (not compared)	none reported	cotinine
Severson et al. (1997)	self-reported smoking within one month of pregnancy, regardless of current smoking status (N=1026)	randomized practices to minimal (I1) or extended intervention (I2)	I1: packet of written materials after delivery I2: packet and interventions during first four well-baby visits	trained pediatricians, nurses & physician assistants	12 mos	I1=26% I2=33% (NS)	partner smoking, less confidence to remain quit, alcohol use, less weight lossc associated with relapse	self report
Secker-Walker et al. (1998)	self-reported nonsmokers recruited at first prenatal visit (N=125)	randomized to UC or I	individual counseling about relapse prevention during pregnancy. Final visit (36 wks) addressed pp period.	trained nurses	12 mos	I=45% C=52% (NS)	none reported	self-reportb
McBride et al. (1999)	smokers recruited at first prenatal visit at large HMO (N=897)	randomized to one of three intervention groups (I1, I2, I3)	I1: booklet only I2: booklet and prenatal calls I3: booklet, prenatal calls and calls, mailings pp	mailings and telephone	8 wks:	I1=56% vs I2=65% I3=67% (p=0.09)	none reported	cotinine
					6 mos:	I1=45%, I2=47% vs. I3=57% (p=0.09)
					12 mos:	I1=42%, I2=42%, I3=43% (NS)
Johnson et al. (2000)	self reported quitters recruited after delivery (N=251)	randomized to UC or I	one individual appointment in the hospital and follow-up telephone callse	trained nurses	6 mos	I=38% C=27% (NS)	high mental healthf, self efficacy for negative affect associated with decreased likelihood of daily smoking	CO or self-reporth
Ratner et al. (2000)g	self reported quitters recruited after delivery (N=238)	randomized to UC or I	one individual appointment in the hospital and follow-up telephone callse	trained nurses	12 mos	I=21% C=19% (NS)	breast feeding, high mental healthf associated with decreased likelihood of daily smoking	CO or self-reporth
Van't Hof et al. (2000)	self reported quitters recruited after delivery (N=287)	randomized to UC or I	one individual appointment	nurses, and trained pediatricians	6 mos	I=42% C=38% (NS)	confidence to stay quit, social encouragement and few smoking friends/family 0 associated with abstinence	self-report
Valanis et al. (2001)	smokers recruited from large HMO at first prenatal appt. (N=2055)	quasi-experimental	videos, letters or self-help brochures; groups compared before during and after staff training	hospital nurses, lactation consultants; pediatric staff	12 mos	I: 14% C:11% (p=0.04)	quitting before first prenatal, older maternal age associated with abstinence	self-report

Note. HMO=Health Maintenance Organization; I=Intervention or Treatment Group; mos=months; NS=No significant difference between groups; pg=pregnancy; pp=postpartum; UC=Usual Care or Control Group.

^aSample size reflects the size used in analysis of postpartum relapse.

^bBoth studies by Secker-Walker et al. focused on preventing relapse to smoking during pregnancy and used urinary cotinine during pregnancy to determine abstinence. Women who had relapsed during pg were also followed pp.

^cWeight loss interacted with treatment condition and relapsing was associated with having lost more weight for mothers in the extended intervention condition (I2).

^d107 of 467 subjects enrolled in the trial provided data on postpartum smoking of whom only 98 were randomized to intervention or UC. Thus, there was insufficient power to evaluate the postpartum intervention.

^eOnly 25% of the participants received all of the eight planned phone calls.

^fUsed a five item measure of mental health.

^gFollow up to the Johnson et al. (2000) study.

^hUsed self report to define smoking status when CO was not collected.