The role of prepartum motivation in the maintenance of postpartum smoking abstinence

Abstract

Objective: Motivation plays an important role in a variety of behaviors, including smoking cessation, and is integral to theory and treatment of smoking. For many women, pregnancy offers a motivational shift that helps them stop smoking and maintain abstinence during pregnancy. However, women's motivation to maintain smoking abstinence postpartum is not well-understood and may play a role in high postpartum relapse rates. The current study utilized multiple measures of prepartum motivation to maintain smoking abstinence to predict postpartum smoking abstinence.

Methods: As part of a randomized clinical trial on postpartum smoking relapse prevention, pregnant women who quit smoking during pregnancy reported their motivation to continue smoking abstinence at a prepartum baseline session. Biochemically verified continued smoking abstinence was assessed at 8 and 26 weeks postpartum.

Results: Direct relationships among multiple measures of motivation were significant, and ranged in strength from weak to moderate. All motivation measures individually predicted continuous smoking abstinence, after controlling for treatment group, demographics, and prequit tobacco use. When tested simultaneously, a global motivation measure and parenthood motives for quitting remained significant predictors of abstinence. Backward selection modeling procedures resulted in a reduced model of prepartum predictors of postpartum abstinence including global motivation, parenthood motives, and stage of change.

Conclusions: Global motivation for smoking abstinence and parenthood motives for quitting are particularly important motivational constructs for pregnant women's continued smoking abstinence.

Figure 1

Individual model estimated probabilities (and standard errors) of postpartum abstinence at weeks 8 and 26. Probabilities estimated for a White, married woman of mean age, who smoked her first cigarette > 5 minutes after waking, who smoked the mean number of cigarettes per day, who had at least a high school education, and was treated with MAPS/MAPS+. TSAMS and motives for quitting were treated as continuous variables in analyses, but were split into four categories for illustrative purposes. Only intrinsic motives for quitting are presented for brevity, as all specific motives demonstrated the same pattern. TSAMS = Texas Smoking Abstinence Motivation Scale.

Figure 2

Reduced model estimated probabilities (and standard errors) of postpartum abstinence at weeks 8 and 26. Probabilities estimated for a White, married woman of mean age, who smoked her first cigarette > 5 minutes after waking, smoked the mean number of cigarettes per day, had at least a high school education, and was treated with MAPS/MAPS+. For TSAMS, analyses assumed the mean score for parenthood motives and precontemplation stage of change. For stage of change, analyses assumed the mean score for TSAMS and parenthood motives. For parenthood motives, analyses assumed the mean score for TSAMS and precontemplation stage of change. TSAMS and parenthood motives were treated as continuous variables in analyses but were split into four categories for illustrative purposes. TSAMS = Texas Smoking Abstinence Motivation Scale.