Correlates of postpartum smoking relapse. Results from the Pregnancy Risk Assessment Monitoring System (PRAMS)

Epidemic Intelligence Service, Epidemiology Program Office, and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
American Journal of Preventive Medicine (Impact Factor: 4.53). 11/2000; 19(3):193-6.
Source: PubMed


Using population-based data from the Pregnancy Risk Assessment Monitoring System (PRAMS), this study examines the prevalence and intensity of smoking before, during, and after pregnancy, and identifies correlates of postpartum smoking relapse.
Women who delivered live births in 1996 responded to a mailed questionnaire approximately 2 to 6 months after delivery (N =17,378). Data from 10 states participating in PRAMS were included in the study, and the overall participation rate was 75%. Analyses were adjusted for survey design and sampling strategy. Logistic regression analysis identified independent correlates of smoking relapse.
Overall, 25.6% of women reported cigarette smoking before pregnancy. Among women who smoked before pregnancy, 44.5% quit during pregnancy. Among women who quit during pregnancy, half relapsed by the time of the survey. Independent correlates associated with increased risk of postpartum relapse included African American race/ethnicity, multiparity, high maternal weight gain, late or no prenatal care, and stressful life events.
Correlates of postpartum smoking relapse identified by this study may contribute to the development of effective and targeted interventions to maintain long-term smoking cessation.

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    • "Recent data from the Centers for Disease Control suggest that African American smoking rates (21.3%) have risen to comparable levels as Caucasian Americans (22%), with higher rates among underserved populations such as individuals with low education, or living in poverty or deprived neighborhoods (CDC, 2008). Additionally, urban-dwelling and low-income African American children suffer the highest rates and levels of SHSe (Carmichael & Ahluwalia, 2000), and bear greater SHSe-related morbidity and mortality burden than other populations (Ahluwalia, 2002). Thus, low-income African American women are not only more likely to be depressed (Pratt & Brody, 2008; USDHHS, 2011), but they also are more likely to smoke and have children with greater levels of SHSe and SHSerelated illness than the general population of women. "
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    ABSTRACT: Maternal smoking and depressive symptoms are independently linked to poor child health outcomes. However, little is known about factors that may predict maternal depressive symptoms among low-income, African American maternal smokers—an understudied population with children known to have increased morbidity and mortality risks. The objective of this study was to test the hypothesis that secondhand smoke exposure (SHSe)-related pediatric sick visits are associated with significant maternal depressive symptoms among low-income, African American maternal smokers in the context of other depression-related factors. Prior to randomization in a behavioral counseling trial to reduce child SHSe, 307 maternal smokers in Philadelphia completed the Center for Epidemiologic Studies Depression (CES-D) and questionnaires measuring stressful events, nicotine dependence, social support, child health and demographics. CES-D was dichotomized at the clinical cutoff to differentiate mothers with significant versus low depressive symptoms. Results from direct entry logistic regression demonstrated that maternal smokers reporting more than one SHSe-related sick visit (OR 1.38, p < .001), greater perceived life stress (OR 1.05, p < .001) and less social support (OR 0.82, p < .001) within the last 3 months were more likely to report significant depressive symptoms than mothers with fewer clinic visits, less stress, and greater social support. These results suggest opportunities for future hypothesis-driven evaluation, and exploration of intervention strategies in pediatric primary care. Maternal depression, smoking and child illness may present as a reciprocally-determined phenomenon that points to the potential utility of treating one chronic maternal condition to facilitate change in the other chronic condition, regardless of which primary presenting problem is addressed. Future longitudinal research could attempt to confirm this hypothesis.
    Journal of Child and Family Studies 10/2013; 22(7). DOI:10.1007/s10826-012-9663-4 · 1.42 Impact Factor
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    • "The specific components of the clinic- and individual-level interventions are informed by the literature, including our preliminary studies and theory [11-13]. For example, research links social support [14], coping skills [15], and self-efficacy [16] to smoking behavior change. The KiSS interventions have elements shown to be associated with improved social support [17], coping skills [18], and self-efficacy [19]. "
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    ABSTRACT: Secondhand smoke exposure (SHSe) harms children's health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice. A multilevel intervention combining pediatric healthcare providers' advice with behavioral counseling and navigation to pharmacological cessation aids may improve SHSe control in pediatric populations.Methods/design: This trial uses a randomized, two-group design with three measurement periods: pre-intervention, end of treatment and 12-month follow-up. Smoking parents of children < 11-years-old are recruited from pediatric clinics. The clinic-level intervention includes integrating tobacco intervention guideline prompts into electronic health record screens. The prompts guide providers to ask all parents about child SHSe, advise about SHSe harms, and refer smokers to cessation resources. After receiving clinic intervention, eligible parents are randomized to receive: (a) a 3-month telephone-based behavioral counseling intervention designed to promote reduction in child SHSe, parent smoking cessation, and navigation to access nicotine replacement therapy or cessation medication or (b) an attention control nutrition education intervention. Healthcare providers and assessors are blind to group assignment. Cotinine is used to bioverify child SHSe (primary outcome) and parent quit status. This study tests an innovative multilevel approach to reducing child SHSe. The approach is sustainable, because clinics can easily integrate the tobacco intervention prompts related to "ask, advise, and refer" guidelines into electronic health records and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines.Trial registration: NCT01745393 (
    BMC Public Health 08/2013; 13(1):792. DOI:10.1186/1471-2458-13-792 · 2.26 Impact Factor
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    • "It has been suggested that women who stop smoking during pregnancy and relapse during the postpartum period (2–6 months) are more likely to be younger (Colman & Joyce, 2003), non-White (Carmichael et al., 2000; Colman & Joyce, 2003), less educated (Colman & Joyce, 2003; Liu, Rosenberg, & Sandoval, 2006), have high parity (Colman & Joyce, 2003), have a partner who smokes (Lelong, Kaminski, Saurel-Cubizolles, & Bouvier-Colle, 2001; Letourneau et al., 2007; Ma et al., 2005; Solomon et al., 2007), be heavier smokers pre-pregnancy (Colman & Joyce, 2003; Solomon et al., 2007) and may suffer feelings of stress or depression (Allen et al., 2009; Carmichael et al., 2000; Park et al., 2009; Solomon et al., 2007); whereas, breast feeding has been suggested be a protective factor (Ratner, Johnson, & Bottorff, 1999). However, little information is available on factors associated with relapse of smoking in the early postpartum period (within the first 6 weeks). "
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    ABSTRACT: Introduction: There is increasing evidence that a high proportion (47%-63%) of women who quit smoking during pregnancy relapse during the postpartum period. The purpose of this population-based study was to examine the association between selected sociodemographic factors and smoking relapse in the early postpartum period (within the first 6 weeks) in women who had successfully quit smoking during the pregnancy. Methods: The study included 512 women resident in East Sussex, United Kingdom, who had quit smoking during the pregnancy. Information on the prevalence of smoking and selected sociodemographic factors and breast feeding at the 6-weeks postpartum review by health visitor was obtained from the Child Health Surveillance System, which records and monitors the health and development of children from birth until school entry. Results: Of the 512 women who had quit smoking during the pregnancy, 238 (46.5%) relapsed in the early postpartum period. In the bivariate analysis, there was an association between deprivation and smoking relapse in the early postpartum period (OR = 5.3, 95% CI: 2.5-11.4), with a significant trend in increasing risk of relapse with increasing level of deprivation (p < .01). Stepwise logistic regression analysis showed that women who lived in deprived urban areas (OR = 2.3, 95% CI: 1.2-4.2), had ≥3 children (OR = 3.8, 95% CI: 2.2-6.4), and had other smokers in the household (OR = 5.6, 95% CI: 3.6-8.8) were significantly more likely to relapse in the early postpartum period. On the other hand, women who were breast feeding were significantly less likely to relapse (OR = 0.6, 95% CI: 0.4-0.9). Conclusions: Factors associated with early postpartum smoking relapse identified in this study, particularly breast feeding, high parity, and concurrent smoking by partner/other household member(s), may contribute to the development of effective and targeted interventions to maintain smoking cessation in women and their household.
    Nicotine & Tobacco Research 10/2012; 15(5). DOI:10.1093/ntr/nts221 · 3.30 Impact Factor
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