***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE A recent theory of motivation ( PRIME theory ) has proposed that the formation of a ' non-smoker ' identity is necessary for long-term abstinence . This study aim ed to explore how a smoker 's sense of identity changes following smoking cessation . DESIGN This was a qualitative , semi-structured interview study with a purposive sample of individuals who had quit smoking . An interpretative phenomenological approach was taken to elicit in-depth accounts of the participants ' underst and ing of smoking , stopping , and maintaining abstinence . METHODS Ten participants who quit smoking with the support of a National Health Service ( NHS ) stop-smoking service in Engl and and were still abstinent a year later were interviewed . An interpretative phenomenological analysis of the interview transcripts was conducted . Prospect i ve context ual detail of motivational and other variables pre-quit were also obtained from the clinic assessment form that participants completed at the first group session . RESULTS A process of identity change was observed towards that of a ' non-smoker ' , assisted initially by a transient identity of ' team stop-smoker ' accompanied by a sense of achievement . All participants retained a residual attraction to smoking suggesting that the process was not complete and reflecting an ' ex-smoker ' identity . Participants labelled themselves as non-smokers regardless of how much transition had occurred . CONCLUSIONS It appears useful to distinguish two levels of ' non-smoker ' identity : a surface level comprising the simple label and a deep level made up of often conflicting thoughts and feelings about oneself in relation to smoking . A total coherent ' non-smoker ' identity does not appear to be necessary for long-term abstinence An intrinsic-extrinsic model of motivation for smoking cessation was evaluated with 2 sample s ( ns = 1.217 and 151 ) of smokers who requested self-help material s for smoking cessation . Exploratory and confirmatory principal components analysis on a 36-item  Reasons for Quitting ( RFQ ) scale supported the intrinsic-extrinsic motivation distinction . A 4-factor model , with 2 intrinsic dimensions ( concerns about health and desire for self-control ) and 2 extrinsic dimensions ( immediate reinforcement and social influence ) , was defined by 20 of the 36 RFQ items . The 20-item measure demonstrated moderate to high levels of internal consistency and convergent and discriminant validity . Logistic regression analyses indicated that smokers with higher levels of intrinsic relative to extrinsic motivation were more likely to achieve abstinence from smoking OBJECTIVE To assess whether perceived changes in postpartum support were associated with postpartum return to smoking . STUDY DESIGN This is a prospect i ve repeated measures , mixed methods observational study . Sixty-five women who smoked prior to pregnancy were recruited at delivery and surveyed at 2 , 6 , 12 , and 24 weeks postpartum ; in-depth interviews were conducted when participants reported smoking . RESULTS Fifty-two percent self identified as White , non-Hispanic . Forty-seven percent resumed smoking by 24 weeks postpartum . Women who had returned to smoking by 24 weeks had a significantly larger decrease in perceived smoking-specific support than women who remained abstinent ( p<0.001 ) . By 24-week postpartum follow-up , only 24 % of women reported that an obstetric clinician had discussed how to quit/stay quit . When qualitatively interviewed , more than half of women reported having no one to support them to stay quit or quit smoking . CONCLUSION Following delivery , women lack needed smoking-specific support . Decline in perceived smoking-specific support from family and friends is associated with postpartum smoking resumption A significant proportion of women who self-quit smoking during pregnancy subsequently relapse to smoking post-partum . This study examined free-text responses describing attributions of smoking relapse or maintained abstinence at 1 , 8 , and 12 months post-partum . This study reports secondary analyses from a r and omized clinical trial ( N = 504 ) for preventing post-partum smoking relapse . At each follow-up , one survey item asked the participant to describe why she resumed smoking or what helped her maintain abstinence . A thematic content analysis was conducted on responses from the 472 participants ( 94.0 % of the original sample ) who returned at least 1 survey . Content analyses revealed several themes for participants ’ reasons for relapse and abstinence . Stress was the most frequently cited reason for smoking relapse across all follow-ups . Health concerns for children and family was the most common reason provided for remaining abstinent . Chi square analyses revealed differences in written responses related to income , age , and depressive symptoms . Overall , these findings suggest that during the post-partum period , stress and familial health concerns are perceived contributors to smoking relapse and abstinence , respectively . These results confirmed key risk and protective factors that have been identified through other assessment modalities ( e.g. , quantitative surveys and focus groups ) . They also provide support for targeting these variables in the development , content , and delivery of future post-partum smoking relapse-prevention interventions . The high response rate to these open-ended attribution questions suggests that future studies would benefit from including these and similar items to allow for additional insight into participant perspectives AIMS To investigate associations between  maternal stress and smoking prior to , during and 6 months after the pregnancy . DESIGN A prospect i ve population -based cohort study . SETTING Norway . PARTICIPANTS A total of 71 757 women in the Norwegian Mother and Child Cohort Study ( MoBa ) participating twice during pregnancy and at 6 months postpartum . MEASUREMENTS Respondents ' estimates of anxiety and depression , relationship discord and negative life events  were measured , along with self-reports of smoking behaviour and demographic variables . Smoking was assessed at gestation weeks 17 and 30 and at 6 months postpartum . FINDINGS Of the 27.5 % women who smoked at conception , 55.8 % quit smoking during pregnancy . At 6 months postpartum , 28.9 % of quitters had relapsed to smoking . In total , 12.9 % of the sample reported smoking during the pregnancy . Adjusted for well-known risk factors , women reporting high levels of anxiety and depression had a decreased likelihood of quitting smoking during pregnancy [ odds ratio ( OR ) 0.80 , 95 % confidence interval ( CI ) : 0.73 , 0.88 ) and an increased likelihood of relapsing after delivery ( OR 1.26 , 95 % CI : 1.11 , 1.44 ) . Both relationship discord ( OR 0.82 , 95 % CI : 0.75 , 0.90 ) and exposure to negative life events ( OR 0.93 , 95 % : CI 0.90 , 0.96 ) had a negative influence on quitting smoking during pregnancy but had no influence on relapse to smoking postpartum . CONCLUSIONS Maternal stress and relationship discord may inhibit smoking cessation during pregnancy and promote resumption of smoking after pregnancy in women who have achieved abstinence 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 r and omized 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 result ed 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 INTRODUCTION The aim of this prospect i ve repeated measures , mixed- methods observational study was to assess whether depressive , anxiety , and stress symptoms are associated with postpartum relapse to smoking . METHODS A total of 65 women who smoked prior to pregnancy and had not smoked during the last month of pregnancy were recruited at delivery and followed for 24 weeks . Surveys administered at baseline and at 2 , 6 , 12 , and 24 weeks postpartum assessed smoking status and symptoms of depression ( Beck Depression Inventory [ BDI ] ) , anxiety ( Beck Anxiety Inventory [ BAI ] ) , and stress ( Perceived Stress Scale [ PSS ] ) .  In-depth interviews were conducted with women who reported smoking . RESULTS Although 92 % of the participants reported a strong desire to stay quit , 47 % resumed smoking by 24 weeks postpartum . Baseline factors associated with smoking at 24 weeks were having had a prior delivery , not being happy about the pregnancy , undergoing counseling for depression or anxiety during pregnancy , and ever having struggled with depression ( p < .05 ) . In a repeated measures regression model , the slope of BDI scores from baseline to the 12-week follow-up differed between nonsmokers and smokers ( -0.12 vs. + 0.11 units/week , p = .03 ) . The slope of PSS scores also differed between nonsmokers and smokers ( -0.05 vs. + 0.08 units/week , p = .04 ) . In qualitative interviews , most women who relapsed attributed their relapse and continued smoking to negative emotions . DISCUSSION Among women who quit smoking during pregnancy , a worsening of depressive and stress symptoms over 12 weeks postpartum was associated with an increased risk of smoking by 24 weeks OBJECTIVE To evaluate the efficacy of a brief smoking cessation intervention with pregnant women practicable routinely by midwives . DESIGN Midwives were r and omized to deliver the experimental intervention or usual care . The 10 - 15-minute intervention was based on brief counselling , written material s , arrangements for continuing self-help support and feedback on expired-air carbon monoxide levels . The intervention was tailored to the women 's needs : those who did not want to stop smoking received a brief motivational intervention , those who wanted to stop received an intervention design ed to assist them and those that had stopped recently ( recent ex-smokers ) received a relapse prevention intervention . SETTING Booking interviews with pregnant women in nine hospital and community trusts . SUBJECTS A total of 1120 pregnant women in the third month of pregnancy ( 249 recent ex-smokers and 871 current smokers ) . MAIN OUTCOME MEASURES Three indicators of biochemically vali date d abstinence were collected . Continuous abstinence for at least 3 months prior to delivery , point prevalence abstinence immediately post-delivery , and continuous abstinence from 3 months pre-delivery to 6 months post-delivery . RESULTS Only a small proportion of the women who would have been eligible to take part in the trial were actually recruited by 178 recruiting midwives , with lack of time being cited as the main barrier . The intervention and usual care groups differed in post-delivery point prevalence abstinence rates for recent ex-smokers ( 65 % vs. 53 % , p < 0.05 , one-tailed ) , but not in other outcome measures . Overall , 54 % of " recent ex-smokers " at booking and 7 % of " current smokers " at booking had been abstinent for at least 3 months at the time of delivery , and 23 % and 3 % , respectively , were still abstinent by the time the child was 6 months old ( i.e. 12 months post-intervention ) . Smoking status at follow-up was predicted by dependence indexed by time to first cigarette in the morning . CONCLUSIONS A brief " one-off " smoking cessation intervention by midwives does not seem to be a practicable or effective method of helping pregnant smokers to stop . Other options such as tailored self-help material s and telephone counselling and other specialist treatments should be examined . Current smoking cessation rates in pregnancy are very low BACKGROUND The purpose of this study was to describe women 's smoking experience during pregnancy and postpartum . Primiparous women recruited during a r and omized controlled trial to assess the effectiveness of postpartum visiting were invited to participate in a qualitative study . METHODS A semistructured protocol guided the face-to-face interview . Interviews were audiotaped and transcribed . Data were coded independently by the authors , and the final coding system for emergent themes was developed through a consensus process . RESULTS Of the 47 women invited to participate , 22 agreed to be interviewed . Three major themes emerged from the analysis : pregnancy as a context for stopping smoking , returning to smoking , and social pressures on smoking behavior . Concerns about the baby 's health were cited as central reasons for stopping . Breastfeeding provided a reason for continued smoking cessation , whereas social events often demarcated a resumption of 
    Output:
    
Factors affecting relapse and barriers and facilitators to relapse prevention were identified around the key themes of beliefs , social influences , motivation , physiological factors and identity .
Women 's beliefs about smoking as a means of coping with stress and the need for social support , especially from a partner , emerged as important .
Extrinsic motivation to quit during the pregnancy ( for the health of the fetus ) appeared to be a factor in prompting relapse after the baby was born .
During the immediate postpartum period women believed that physiological changes influence cigarette cravings .
The stress of caring for a newborn , sleeplessness and adjusting to a new mothering identity were also reported to be important .
Among women who quit smoking during pregnancy , those who relapse postpartum talk commonly about no longer needing to protect the baby and the effects of stress .
Partner support and a sense of changed identity are cited as factors preventing relapse