The Role of Self-Efficacy and Motivation in Postpartum Sustained Smoking Abstinence

Postpartum relapse to cigarette smoking is common and relapse prevention interventions have indicated limited efficacy. Abstinence motivations and self-efficacy are two factors that might fluctuate during the postpartum period and predict smoking abstinence. The present study was a secondary analysis that examined statistical trends in motivations and self-efficacy to sustain postpartum abstinence and evaluated their association with sustained abstinence from pregnancy through 52 weeks postpartum.

Former smokers (N = 300) were recruited for a parent study evaluating two postpartum behavioral relapse prevention interventions. Participants completed assessments prenatally (baseline) and at 12, 24, and 52 weeks postpartum. Motivations to sustain abstinence for internal (intrinsic motivation) and external (extrinsic motivation) reasons, for the health of the baby (baby's health motivation), to maintain a healthy pregnancy (pregnancy motivation), and to avoid children becoming smokers (parenting motivation) were measured at each assessment. Confidence in maintaining abstinence, despite negative affective experiences (internal self-efficacy) and outside circumstances (external self-efficacy), was also assessed. Smoking was biochemically verified at each assessment.

Linear mixed models indicated decreasing intrinsic, baby's health, and parenting motivations from baseline to 12 and 24 weeks postpartum and increasing motivations from 24 to 52 weeks postpartum (ps < .03). Higher baseline internal self-efficacy was associated with lower probability of relapse at 24 weeks postpartum (odds ratio, 0.92; 95% CI, 0.87-0.98), although this effect became nonsignificant after adjustment for multiple statistical tests. Abstinence motivations and external self-efficacy were not significantly associated with relapse (ps > .10).

Levels of abstinence motivations fluctuated from pregnancy through postpartum. Future work should investigate more potent predictors of postpartum abstinence.