Article

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

ABSTRACT

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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    • "This paper also presents findings from mediation analyses that test two hypothesized pathways through which terminating versus continuing an unwanted pregnancy relates to subsequent binge alcohol use: stress/coping and social roles. Stressful events have been linked to alcohol use in general (Hasin et al., 2007), heavy drinking in pregnancy (May et al., 2000), and postpartum tobacco relapse (Carmichael and Ahluwalia, 2000). Pregnancy termination has been hypothesized as a stressful or traumatic event resulting in alcohol and drug disorders (Coleman, 2005;Coleman et al., 2005Coleman et al., , 2002Pedersen, 2007). "
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    ABSTRACT: Background: Women who terminate pregnancies drink more subsequent to the pregnancy than women who give birth, including women who give birth after seeking to terminate a pregnancy. Methods: Data are from the Turnaway Study, a prospective, longitudinal study of 956 women who sought to terminate pregnancies at 30 U.S. facilities. This paper focuses on the 452 women who received terminations just below facility gestational limits and 231 who were denied terminations because they presented just beyond facility gestational limits. This study examined whether baseline characteristics moderate the relationship between termination and subsequent binge drinking and whether stress, feelings about the pregnancy, and number of social roles mediate the relationship. Results: Only having had a previous live birth modified the termination-binge drinking relationship. Among women with previous live births, binge drinking was reduced among women carrying to term compared to terminating the pregnancy. Among women who had not had a previous live birth, however, the reduction in binge drinking among those denied termination was not sustained over time, and binge drinking of those who had and had not had terminations converged by 2.5 years. Neither stress, negative emotions, nor social roles mediated effects on binge drinking. Positive emotions at one week mediated effects on binge drinking at six months, although positive emotions at two years did not mediate effects on binge drinking at 2.5 years. Conclusions: Higher levels of binge drinking among those who terminate pregnancies do not appear due to stress or to negative emotions. Only parous women - and not nulliparous women - denied terminations experienced sustained reductions in binge drinking over time.
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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.
    Full-text · Article · Oct 2013 · Journal of Child and Family Studies
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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 (clinicaltrials.gov).
    Full-text · Article · Aug 2013 · BMC Public Health
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