Learning Objective #1: Discuss the adequacy and clinical usefulness of the Theory of Planned Behavior to the study of postpartum smoking behaviors

Learning Objective #2: Identify modal behavioral, normative, and control beliefs in the study, and relate how these beliefs can be used to develop effective family-centered tobacco cessation interventions

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Background: Smoking is the leading preventable cause of death in the United States. Family members, including children exposed to environmental tobacco smoke suffer significant morbidity. Many women stop smoking during pregnancy, and most relapse following delivery, yet postpartum smoking has received little study. Behavioral, normative, and perceived behavioral control beliefs about smoking from postpartum women in the Military Health System (MHS) were elicited using the Theory of Planned Behavior. These beliefs were later used to construct items for the “The Postpartum Smoking Questionnaire (PPSQ)”.

Methods: Content analysis was used to analyze transcripts from audiotaped interviews with 35 postpartum women. Modal beliefs related to advantages and disadvantages (behavioral); significant referents (normative); and perceived facilitators and barriers (control) to postnatal smoking were identified. All the women had been smoking when they became pregnant. Current and former smokers participated.

Results: Beliefs that prevented women from smoking included: worrying about family members' health, desire to be a positive role model for children, and to live longer. Stress management, addiction, and getting breaks from the baby were modal beliefs that reinforced smoking. Participants' mothers were revealed as persons who both approved and disapproved of postpartum smoking. Smoking was also reported as part of one's social identity and viewed as a common bond with fellow smokers.

Conclusions: Suggested interventions include: (a) ways to increase disclosure of pre and postnatal smoking status; (b) capitalizing on motivation to be a positive role model during prenatal and well-baby visits; (c) recognize and acknowledge that smoking is sometimes viewed as a “lesser evil” when compared to other addictions (e.g., previous illicit drug use); (d) smoking is often used by postpartum women to control stress, including demands of motherhood; (e) acknowledge the role of partners' smoking; and (f) institute cessation programs that are “family-friendly” (e.g., allow infants, conduct in childcare centers).