Publication Date



randomized control trial, smoking cessation, nicotine dependence, socioeconomic status, pregnancy, postpartum, smoking relapse


Purpose: Smoking during pregnancy can have dire consequences for both the baby and mother. Low-income pregnant women smoke at particularly high rates. Among women who quit during pregnancy, postpartum relapse is high. This randomized control trial tested the effect of adding postpartum assistance to an existing smoking cessation program (First Breath) designed for low-income women.

Methods: Of 185 study participants, 94 women were randomly assigned to the standard First Breath program (control) and 91 to an enhanced program. First Breath consisted of evidence-based smoking cessation counseling provided at every prenatal visit. The enhanced program included all First Breath services plus 4 in-home counseling visits (3 postpartum), 3 postpartum counseling calls, support to others in the home, and incentives (gift cards) totaling $100. The primary outcome was biochemically verified abstinence at 6 months postpartum.

Results: Among the 98 women who completed the study, the abstinence rate among the intervention participants (n = 41) was significantly greater than among the control participants (n = 57) (36.6% vs 12.3%, respectively; P < 0.01). Analyzed on an intent-to-treat basis, with those lost to follow-up assumed to be smoking, the abstinence rate among intervention subjects (n = 91) was 16.5% vs 7.4% among control participants (n = 94); P = 0.07.

Conclusions: Extending smoking cessation interventions into the postpartum period may help address postpartum relapse.

Appendix A.pdf (211 kB)
Online Appendix A

Appendix B.pdf (356 kB)
Online Appendix B




February 26th, 2019


May 16th, 2019


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