Self-help booklets for preventing postpartum smoking relapse: a randomized trial

Abstract

Objectives: We tested a series of self-help booklets designed to prevent postpartum smoking relapse.

Methods: We recruited 700 women in months 4 through 8 of pregnancy, who quit smoking for their pregnancy. We randomized the women to receive either (1) 10 Forever Free for Baby and Me (FFB) relapse prevention booklets, mailed until 8 months postpartum, or (2) 2 existing smoking cessation materials, as a usual care control (UCC). Assessments were completed at baseline and at 1, 8, and 12 months postpartum.

Results: We received baseline questionnaires from 504 women meeting inclusion criteria. We found a main effect for treatment at 8 months, with FFB yielding higher abstinence rates (69.6%) than UCC (58.5%). Treatment effect was moderated by annual household income and age. Among lower income women (< $30 000), treatment effects were found at 8 and 12 months postpartum, with respective abstinence rates of 72.2% and 72.1% for FFB and 53.6% and 50.5% for UCC. No effects were found for higher income women.

Conclusions: Self-help booklets appeared to be efficacious and offered a low-cost modality for providing relapse-prevention assistance to low-income pregnant and postpartum women.

FIGURE 1—

CONSORT flow diagram: Self-Help Booklets for Preventing Postpartum Smoking Relapse, 2004–2008 Note. FFB = Forever Free for Baby and Me booklets; UCC = usual care control.

FIGURE 2—

Treatment effects as a function of annual household income (a) ≤ $30 000 and (b) > $30 000: Self-Help Booklets for Preventing Postpartum Smoking Relapse, 2004–2008.