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Garey L, Thai JM, Zvolensky MJ, Smits JAJ. Exercise and Smoking Cessation. Curr Top Behav Neurosci 2024. [PMID: 39090290 DOI: 10.1007/7854_2024_497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Smoking is a public health crisis, leading to a multitude of health complications. Exercise is associated with numerous health benefits and is accepted by health professionals and smokers as a potentially effective smoking cessation aid. This chapter discusses the extant literature on the relation between exercise and smoking, including cross-sectional studies, experiments, and randomized clinical trials. There is robust evidence for exercise's efficacy in reducing cigarette craving, tobacco withdrawal symptoms, and negative affect. Further, exercise-based interventions appear to boost short-term abstinence yet may fall short of facilitating long-term abstinence. Methodological limitations of extant work are reviewed. We conclude with a discussion of the next steps in this line of work to fine-tune exercise interventions and their application for smoking cessation.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Jessica M Thai
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jasper A J Smits
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
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Kilmurray C, Vander Weg M, Wilson N, Relyea G, McClanahan B, Stockton MB, Ward KD. Determinants of smoking related weight-concern in smokers participating in a community-based cessation program. Eat Behav 2023; 51:101809. [PMID: 37699309 PMCID: PMC10840988 DOI: 10.1016/j.eatbeh.2023.101809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/18/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Concern about weight gain is a barrier to smoking-cessation, but determinants of postcessation weight-concern have not been comprehensively assessed in the context of community-based cessation programs. METHODS This cross-sectional analysis used baseline data from a cessation trial of 392 adults randomized to physical activity (PA) or general wellness counseling as adjunctive treatment for smoking. Outcomes were 1) smoking behaviors to control weight and 2) anticipating relapse due to weight gain. Independent variables were PA and perceptions, sociodemographics, psychosocial measures, smoking behavior and perceptions, diet, and BMI. From bivariable models examining main and sex interaction effects, significant variables were entered into a linear (control) or logistic (relapse) regression model to identify key determinants. RESULTS For both measures, weight-concern was greater (p < .05) for female smokers (standardized b = 0.52, SE = 0.10; OR = 0.29, 95 % CI = 0.17-0.49), White (b = 0.12, SE = 0.05; OR = 0.39, 95 % CI = 0.23-0.66), and less motivated to quit (b = -0.14, SE = 0.05; OR = 0.77, 95 % CI = 0.59-1.0). Higher scores for smoking to control weight were associated with less PA (b = -0.10, SE = 0.05) and higher BMI (b = 0.21, SE = 0.05). For men, higher BMI was associated with greater anticipation of relapse (OR = 2.54, 95 % CI = 1.42-4.56). CONCLUSIONS Among adults attempting cessation, women, White smokers, and those less motivated to quit were more likely to smoke for weight control and to relapse due to weight gain. Higher BMI was associated with greater anticipation of relapse for men, but not women. Weight-concerns, for both measures, were not related to smoking history, psychosocial functioning, PA engagement or attitudes, or dietary variables. Results suggest potential cessation intervention targets for weight-concerned smokers.
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Affiliation(s)
- Cheri Kilmurray
- School of Health Studies, The University of Memphis, Memphis, TN 38152, USA; School of Public Health, The University of Memphis, Memphis, TN 38152, USA.
| | - Mark Vander Weg
- University of Iowa, Iowa City VA Health Care System, Iowa City, IA 52242, USA.
| | - Nancy Wilson
- School of Public Health, The University of Memphis, Memphis, TN 38152, USA.
| | - George Relyea
- School of Public Health, The University of Memphis, Memphis, TN 38152, USA
| | - Barbara McClanahan
- School of Health Studies, The University of Memphis, Memphis, TN 38152, USA.
| | - Michelle B Stockton
- School of Health Studies, The University of Memphis, Memphis, TN 38152, USA.
| | - Kenneth D Ward
- School of Public Health, The University of Memphis, Memphis, TN 38152, USA.
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Kuo CW, Lin CF, Chen CY, Wang RH, Chou CY, Cheng HJ, Wu JS, Chen CW, Shieh CC, Yu T. Body-Weight Gain in Women During Smoking Cessation Is a Sex-Specific Predictor of 6-Month Abstinence: A Retrospective Cohort Study. Front Public Health 2022; 10:872220. [PMID: 35646773 PMCID: PMC9139838 DOI: 10.3389/fpubh.2022.872220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSmoking behavior differs between the sexes. Weight control is one of the main reasons leading to tobacco abuse in women but not in men. Studies on the predictive factors of cessation failure between sexes are scarce. This study is aim to investigate whether there are sex differences in the effect of weight gain on smoking cessation rate.MethodsParticipants in the smoking-cessation program at a Medical Center in Taiwan between 2018 and 2019 were included. Details of age, sex, comorbidities, depression screening, nicotine dependence, body weight, and cessation medications of the participants were collected. The participants were classified based on their sex, and multivariable logistic regression analyses were conducted. Multivariable logistic regression analyses were performed for sensitivity analysis after stratifying the participants according to their weight loss (weight loss ≥ 1.5 kg and weight loss ≥ 3.0 kg).ResultsA total of 1,475 participants were included. The body-weight gain in women was associated with failed abstinence (adjusted odds ratio (OR): 3.10, 95% CI: 1.10–9.04). In contrast, body-weight gain in men was associated with successful 6-month prolonged abstinence (adjusted OR: 0.77, 95% CI: 0.61–0.98). The adjusted ORs for any body-weight loss, body-weight loss ≥1.5 kg, and body-weight loss ≥3.0 kg were 0.28 (95% CI: 0.09–0.88), 0.14 (95% CI: 0.03–0.55), and 0.03 (95% CI: 0.01–0.42), respectively.ConclusionBody-weight gain in women during a hospital-based smoking-cessation program is associated with abstinence failure. Further multicenter studies, including participants of different races and cultural backgrounds, are warranted.
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Affiliation(s)
- Chin-Wei Kuo
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Fu Lin
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chuan-Yu Chen
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Health Promotion Association, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ru-Hsueh Wang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Ying Chou
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiang-Ju Cheng
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Wen Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chang Shieh
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Tsung Yu
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De Genna NM, Germeroth LJ, Benno MT, Wang B, Levine MD. Cohort Study of Cannabis Use History and Perinatal Cigarette Use Among Overweight and Obese Women. Matern Child Health J 2022; 26:389-396. [PMID: 34623574 PMCID: PMC8816869 DOI: 10.1007/s10995-021-03246-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES In non-pregnant populations, cannabis use and cannabis use disorder (CUD) have been linked to tobacco use and less successful quit attempts. We compared perinatal cigarette use in women across 3 groups: never used cannabis (No CU group); used cannabis but did not meet CUD criteria (CU group); history of CUD (CUD group). METHODS Interviews with 257 pregnant women with overweight/obesity (M age = 28 years; 52% white) were conducted for a study of eating behavior in Western Pennsylvania from 2012-2016. Tobacco use was assessed early in pregnancy (< 20 weeks gestation), late in pregnancy (34-38 weeks gestation) and 6 months postpartum. CUD was measured with the Structured Clinical Interview for DSM-IV (SCID). Data relevant to the proposed analyses were available for 252 women. Generalized mixed effect models were used to predict perinatal cigarette use based on cannabis use group, time and their interaction, adjusting for age, race, education, income, parity, and mood/anxiety disorder. RESULTS Forty-eight percent of participants reported prior cannabis use and 15% were diagnosed with lifetime CUD. History of cannabis use predicted cigarette smoking in early pregnancy (OR 11.12, CI 3.27-37.85), late pregnancy (OR 6.55, CI 1.70-25.27), and 6 months postpartum (OR 7.57, CI 2.72-21.07), regardless of CUD. CONCLUSIONS A history of CUD did not appear to confer additional risk for perinatal cigarette use. Given increasing rates of cannabis use among pregnant women, these results highlight the importance of addressing history of cannabis use in conjunction with tobacco use to improve smoking cessation efforts.
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Affiliation(s)
- Natacha M. De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine and Department of Epidemiology, Graduate School of Public Health. 3811 O’Hara St, Pittsburgh, PA 15213 USA
| | - Lisa J. Germeroth
- Department of Psychiatry, University of Pittsburgh School of Medicine. 3811 O’Hara St, Pittsburgh, PA 15213 USA
| | - Maria Tina Benno
- School of Education, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282
| | - Bang Wang
- Department of Statistics, University of Pittsburgh. 1826 Wesley W. Posvar Hall, 230 S Bouquet Street. Pittsburgh, PA 15260 USA
| | - Michele D. Levine
- Departments of Psychiatry, Psychology and Obstetrics, Gynecology and Reproductive Sciences at the University of Pittsburgh School of Medicine. 3811 O’Hara St, Pittsburgh, PA 15231 USA
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Smoking and Smoking Relapse in Postpartum: A Systematic Review and Meta-analysis. ADDICTIVE DISORDERS & THEIR TREATMENT 2021. [DOI: 10.1097/adt.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Allen S, Thomas J, Harrison K, Emery RL, Petersen A, Winickoff JP, Japuntich S. Bupropion for postpartum smoking relapse: A remote protocol for a two-arm, double-blind, placebo-controlled randomized clinical trial. Contemp Clin Trials 2021; 105:106352. [PMID: 33706003 PMCID: PMC8499393 DOI: 10.1016/j.cct.2021.106352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/21/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022]
Abstract
Cigarette smoking among postpartum women remains a significant public health problem despite known health risks to women and their newborns. It is estimated that over 50% of women quit smoking during pregnancy but 90% relapse by one year. Safe and effective postpartum relapse prevention strategies are urgently needed. In an attempt to address this deficit, we will investigate the efficacy of bupropion vs. placebo as a smoking relapse prevention aid in postpartum women. The objective of this paper is to detail an approach to investigate bupropion's efficacy for preventing postpartum smoking relapse among women who quit smoking during pregnancy. Specifically, we designed a two-arm, double-blind, placebo-controlled randomized trial testing the efficacy of bupropion vs. placebo as a relapse prevention tool. Mothers of healthy infants who quit smoking while pregnant will be stratified based on current or past history of major depressive disorder or persistent depressive disorder and randomized to receive either active (bupropion XL 300 mg/day) or placebo medication for 12 weeks. To respond to safety concerns associated with participant and staff exposure to COVID-19, we revised our original protocol and present procedures which allow our trial to be conducted entirely remotely. Primary and secondary outcomes will be assessed at weeks 12, 24, 36 and 52 post-randomization. The primary outcome is 7-day point prevalence abstinence at 24 weeks. Results of this work have the potential to positively impact women and their children by promoting lifelong cessation, eliminating secondhand smoke exposure, and modelling of abstinence to children.
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Affiliation(s)
- Sharon Allen
- University of Minnesota, Department of Family Medicine and Community Health, 516 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - Janet Thomas
- University of Minnesota, Department of Medicine, Division of General Internal Medicine, Program in Health Disparities Research, 717 Delaware Street, SE, Suite 166, Minneapolis, MN 55414, USA.
| | - Katherine Harrison
- University of Minnesota, Department of Family Medicine and Community Health, 717 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - Rebecca L Emery
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, 300 West Bank Office Building, Minneapolis, MN 55455, USA.
| | - Ashley Petersen
- University of Minnesota School of Public Health, Division of Biostatistics, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | - Jonathan P Winickoff
- MassGeneral Hospital for Children, Division of General Pediatrics, 125 Nashua Street, Boston, MA 02114, USA.
| | - Sandra Japuntich
- Hennepin Healthcare, Department of Clinical Pharmacology and Toxicology, University of Minnesota Medical School, Department of Medicine, 701 Park Ave. S.9.303, Minneapolis, MN 55415, USA.
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Prediction of Smoking Abstinence in Women Living With Human Immunodeficiency Virus Infection. Nurs Res 2020; 69:167-175. [PMID: 31977840 DOI: 10.1097/nnr.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study examined whether baseline negative emotional states (depression and anxiety) would predict craving for cigarettes and other nicotine withdrawal symptoms in early abstinence and whether those emotional states and withdrawal symptoms would predict failure in quitting smoking at 3 months postquit among U.S. women living with the human immunodeficiency virus (HIV). METHOD The study is a secondary analysis of data from two smoking cessation studies of women living with HIV. Craving for cigarettes and other withdrawal symptoms were assessed weekly with a total of 229 observations during the first 4 weeks following quit day. Descriptive statistics were used to examine baseline characteristics of the participants. A random growth curve model was used to estimate between-person differences in a within-person trend of changes in the withdrawal symptoms. A binary logistic regression analysis was performed to identify predictors of short-term smoking abstinence. RESULTS Baseline anxiety was a predictor of postquit nicotine withdrawal symptoms but baseline depression was not. Neither baseline anxiety nor depression predicted postquit craving for cigarettes. Participants who received an HIV-tailored smoking cessation intervention showed a greater decline in craving symptom than those who received an attention-controlled intervention. HIV-tailored intervention and less craving predicted smoking abstinence at 3-month follow-up. DISCUSSION Compared to an attention-controlled intervention, an HIV-tailored intervention effectively decreased craving for cigarette smoking after quitting-which effectively increased the rate of short-term smoking abstinence in women living with HIV.
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Perdriolle-Galet E, Peyronnet V, Bertholdt C. [Management of Resumption Risk in Postpartum for Women who Quit Smoking During Pregnancy - CNGOF-SFT Expert Report and Guidelines for Smoking Management During Pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:619-624. [PMID: 32247855 DOI: 10.1016/j.gofs.2020.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
According to the 2016 National Perinatal Survey, 30.0 % of women smoked before pregnancy, 45.8 % quit smoking in the 1st or 2nd trimester. Many do this only for pregnancy and the risk of postpartum relapse is high (up to 82 % at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. No drug treatment can be recommended to prevent the smoking postpartum relapse. Only global counseling can prevent this risk.
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Affiliation(s)
- E Perdriolle-Galet
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France.
| | - V Peyronnet
- Service de gynécologie-obstétrique, université de Paris, hôpital Louis Mourier, 92700 Colombes, France
| | - C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
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Levine MD, Emery RL, Kolko Conlon RP, Marcus MD, Germeroth LJ, Salk RH, Cheng Y. Depressive Symptoms Assessed Near the End of Pregnancy Predict Differential Response to Postpartum Smoking Relapse Prevention Intervention. Ann Behav Med 2020; 54:119-124. [PMID: 31219152 PMCID: PMC7170725 DOI: 10.1093/abm/kaz026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressive symptoms are prevalent during pregnancy and the postpartum period and affect risk for smoking relapse. Whether and how depression affects response to postpartum interventions designed to sustain smoking abstinence is unknown. PURPOSE We examined end-of-pregnancy depressive symptoms as a moderator of response to two postpartum-adapted smoking relapse prevention interventions. METHODS Women (N = 300) who quit smoking during pregnancy were randomized to receive either a postpartum intervention focused on psychosocial factors linked to postpartum smoking (Strategies to Avoid Returning to Smoking [STARTS]) or an attention-controlled comparison intervention (SUPPORT). Women completed the Edinburgh Postnatal Depression Scale at the end of pregnancy. Smoking status was biochemically assessed at the end of pregnancy and at 12, 24, and 52 weeks postpartum. RESULTS End-of-pregnancy depressive symptoms moderated response to postpartum smoking relapse prevention interventions (χ2 = 10.18, p = .001). After controlling for variables previously linked to postpartum smoking relapse, women with clinically significant end-of-pregnancy depressive symptoms (20%) were more likely to sustain abstinence through 52 weeks postpartum if they received STARTS. In contrast, women with few end-of-pregnancy depressive symptoms were more likely to sustain abstinence through 52 weeks postpartum if they received SUPPORT. Changes in the psychosocial factors addressed in the STARTS intervention did not mediate this moderation effect. CONCLUSION Assessment of end-of-pregnancy depressive symptoms may help determine success following postpartum smoking relapse prevention interventions. Women with elevated end-of-pregnancy depressive symptoms benefited from postpartum relapse prevention intervention tailored to their psychosocial needs, while those with few symptoms were more successful in postpartum intervention that used standard behavioral components. CLINICAL TRIAL REGISTRATION NCT00757068.
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Affiliation(s)
- Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebecca L Emery
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Marsha D Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa J Germeroth
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel H Salk
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yu Cheng
- Department of Statistics and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Kang D, Fairbairn CE, Ariss TA. A meta-analysis of the effect of substance use interventions on emotion outcomes. J Consult Clin Psychol 2019; 87:1106-1123. [PMID: 31724427 PMCID: PMC6859954 DOI: 10.1037/ccp0000450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Emotional distress has been posited as a key underlying mechanism in the development and maintenance of substance use disorder (SUD), and patients seeking SUD treatment are often experiencing high levels of negative emotion and/or low levels of positive emotion. But the extent to which SUD interventions impact emotional outcomes among general SUD populations is yet unquantified. The current meta-analysis aims to fill this gap. METHOD A total of 11,754 records were screened for randomized, controlled trials examining the effect of behavioral SUD interventions on emotion outcomes. Our search yielded a total of 138 effect sizes calculated based on data from 5,146 individuals enrolled in 30 independent clinical trials. Random-effects meta-analysis was used to calculate pooled effect sizes, and metaregression analyses examined study-level moderators (e.g., intervention type). RESULTS Findings indicated a small but significant effect of SUD interventions on emotion outcomes, d = 0.157, 95% CI [0.052, 0.262] (k = 30). The effect size for negative emotion was nominally bigger, d = 0.162, 95% CI [0.056, 0.269] (k = 30), whereas the effect for positive emotion did not reach statistical significance, d = 0.062, 95% CI [-0.089, 0.213] (k = 7). Studies featuring SUD interventions designed to specifically target emotions (i.e., affect-regulation, mindfulness-based treatments) produced larger reductions in negative emotion compared with studies featuring interventions that did not contain specific emotion modules (e.g., contingency management). CONCLUSIONS Findings suggest that SUD interventions-especially mindfulness-based and affect-regulation treatments-indeed significantly reduce negative emotion, although relatively small effect sizes indicate potential room for improvement. Conclusions regarding positive emotion should be considered preliminary because of the limited numbers of samples assessing these outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Abstract
OBJECTIVE This study aimed to determine the relationship between smoking relapse and breastfeeding and body mass index in the postpartum period. METHODS This descriptive, cross-sectional study was conducted between November 2016 and November 2017 in the polyclinic for children's health and common illnesses at a university hospital in eastern Turkey. One hundred eleven women who met the inclusion criteria constituted the sample of the study. The data were evaluated using the analyses of percentage, arithmetic mean, standard deviation, independent-samples t test, analysis of variance, and multiple linear regression. RESULTS In the study, the week of pregnancy period when the women quit smoking was 8.19 ± 5.17, and the week of postpartum smoking relapse was 8.47 ± 11.76. Furthermore, 72.1% of the women stated that they wanted to quit smoking permanently. The study determined that the status of wanting to quit smoking permanently, the status of smoking while breastfeeding, and gained weight during the last gestation are important predictors of postpartum smoking relapse. ORIGINALITY AND VALUE Knowledge on the characteristics of the women who started smoking again in the postpartum period is important for helping women who have quitted smoking in pregnancy but who are prone to relapse as a risk group by health care personnel.
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Allen A, Tosun N, Carlson S, Allen S. Postpartum Changes in Mood and Smoking-Related Symptomatology: An Ecological Momentary Assessment Investigation. Nicotine Tob Res 2018; 20:681-689. [PMID: 28575412 PMCID: PMC5934674 DOI: 10.1093/ntr/ntx118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/25/2017] [Indexed: 11/14/2022]
Abstract
Introduction Postpartum smoking relapse is a highly prevalent public health problem. Mood and breast feeding are significantly associated with smoking relapse, although less is known about the temporality of these relationships. Therefore, this study utilized ecological momentary assessments (EMA) to prospectively examine changes in mood and smoking-related symptomatology in relationship to three events-childbirth, termination of breast feeding, and smoking relapse. We expected all three events to significantly alter mood and smoking-related symptomatology. Methods We enrolled a sample of pregnant women who had recently quit smoking and intended to remain quit during the postpartum. Participants were randomized to active/placebo progesterone to prevent postpartum relapse. Participants also completed daily EMA to collect data mood and smoking-related symptomatology as well as our three events of interest. Results Participants (n = 46) were, on average, 26.5 ± 0.8 years old and, prior to pregnancy, smoked 10.1 ± 0.7 cigarettes/day. We noted a number of significant within- and between-subject relationships. For example, participants reported a 24% decline in negative affect after childbirth (p = .0016). Among those who relapsed to smoking (n = 23), participants randomized to placebo had a significant increase in cigarette craving after relapse (β = 1.06, 95% confidence interval [CI] = 0.62 to 1.49, p value = .0003), whereas participants randomized to active progesterone did not (β = 0.63, 95% CI = -0.35 to 1.62, p value = .1824). Conclusions These observations suggest that mood and smoking-related symptomatology are influenced by childbirth, breast feeding, smoking relapse, and use of exogenous progesterone. Future research should explore how these observations may inform novel postpartum smoking relapse-prevention interventions. Implications Postpartum smoking relapse has been a persistent public health problem for more than 40 years. Although a number of significant predictors of postpartum smoking relapse have been identified (eg, depression and breast feeding), much of these analyses have relied on cross-sectional and/or self-reported retrospective data. Therefore, for the first time, we utilized ecological momentary assessment to explore the effect of childbirth, termination of breast feeding, and smoking relapse on mood and smoking-related symptomatology (eg, craving). Numerous significant relationships were observed, including a 96% increase in craving after smoking relapse. These novel observations can inform new and effective postpartum smoking relapse-prevention programs.
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Affiliation(s)
- Alicia Allen
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN
| | - Nicole Tosun
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN
| | - Samantha Carlson
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN
| | - Sharon Allen
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN
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13
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Development and evaluation of a mother-centered toolkit for postpartum behavioral and psychosocial health. J Behav Med 2018; 41:591-599. [DOI: 10.1007/s10865-018-9928-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/24/2018] [Indexed: 11/11/2022]
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14
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Heppner WL, Spears CA, Correa-Fernández V, Castro Y, Li Y, Guo B, Reitzel LR, Vidrine JI, Mazas CA, Cofta-Woerpel L, Cinciripini PM, Ahluwalia JS, Wetter DW. Dispositional Mindfulness Predicts Enhanced Smoking Cessation and Smoking Lapse Recovery. Ann Behav Med 2017; 50:337-47. [PMID: 26743533 DOI: 10.1007/s12160-015-9759-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although mindfulness has been hypothesized to promote health behaviors, no research has examined how dispositional mindfulness might influence the process of smoking cessation. PURPOSE The current study investigated dispositional mindfulness, smoking abstinence, and recovery from a lapse among African American smokers. METHODS Participants were 399 African Americans seeking smoking cessation treatment (treatments did not include any components related to mindfulness). Dispositional mindfulness and other psychosocial measures were obtained pre-quit; smoking abstinence was assessed 3, 31 days, and 26 weeks post-quit. RESULTS Individuals higher in dispositional mindfulness were more likely to quit smoking both initially and over time. Moreover, among individuals who had lapsed at day 3, those higher in mindfulness were more likely to recover abstinence by the later time points. The mindfulness-early abstinence association was mediated by lower negative affect, lower expectancies to regulate affect via smoking, and higher perceived social support. CONCLUSIONS Results suggest that mindfulness might enhance smoking cessation among African American smokers by operating on mechanisms posited by prominent models of addiction.
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Affiliation(s)
- Whitney L Heppner
- Department of Psychological Science, Georgia College & State University, Milledgeville, GA, USA.
| | - Claire Adams Spears
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | | | - Yessenia Castro
- School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Yisheng Li
- Department of Biostatistics, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Beibei Guo
- Department of Experimental Statistics, Louisiana State University, Baton Rouge, LA, USA
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Jennifer Irvin Vidrine
- Stephenson Cancer Center and Department of Family & Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Carlos A Mazas
- Department of Health Disparities Research, UT MD Anderson Cancer Center, Houston, TX, USA
| | | | - Paul M Cinciripini
- Department of Behavioral Science, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Jasjit S Ahluwalia
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - David W Wetter
- Department of Psychology, Rice University, Houston, TX, USA
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15
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Hartley E, Hill B, McPhie S, Skouteris H. The associations between depressive and anxiety symptoms, body image, and weight in the first year postpartum: a rapid systematic review. J Reprod Infant Psychol 2017. [PMID: 29517302 DOI: 10.1080/02646838.2017.1396301] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to conduct a rapid systematic review of the evidence of associations between postpartum depressive symptoms, anxiety symptoms, body image and weight status in the first 12 months post birth. BACKGROUND The postpartum period places the mother and infant at risk of a number of negative health outcomes. Mental health conditions such as depression and anxiety are common in the postpartum, as are poor body image and excessive weight retention as women adjust to their post pregnancy body. However, the associations between body image, weight status and psychological distress are not currently well understood. METHODS Articles in English, published between 2006 and 2017, involving singleton pregnancies of normally developing infants and maternal depression or anxiety were eligible for this systematic review. RESULTS From the total of 1805 articles located, 12 were identified as relevant and were subsequently reviewed in full. In the nine studies of depressive symptoms, body image or weight status, four found a significant relationship. Significant associations were not found in the three studies investigating postpartum anxiety symptoms, body image or weight. Body dissatisfaction was associated significantly with poorer postpartum weight status in all nine studies. CONCLUSIONS Further research is needed to determine the nature of the relationships between body image, weight status and depressive and anxiety symptoms across the first year after birth. This information will assist health professionals to promote healthy lifestyle behaviours in the postpartum, as well as inform clinical interventions that target behaviour change to prevent the worsening of these issues and related negative outcomes.
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Affiliation(s)
- Eliza Hartley
- a School of Psychology , Deakin University , Geelong , Australia
| | - Briony Hill
- a School of Psychology , Deakin University , Geelong , Australia
| | - Skye McPhie
- a School of Psychology , Deakin University , Geelong , Australia
| | - Helen Skouteris
- a School of Psychology , Deakin University , Geelong , Australia
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16
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Orton S, Coleman T, Coleman-Haynes T, Ussher M. Predictors of Postpartum Return to Smoking: A Systematic Review. Nicotine Tob Res 2017; 20:665-673. [DOI: 10.1093/ntr/ntx163] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/19/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Sophie Orton
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tom Coleman-Haynes
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St. Georges, University of London, London, UK
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17
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Spears CA, Hedeker D, Li L, Wu C, Anderson NK, Houchins SC, Vinci C, Hoover DS, Vidrine JI, Cinciripini PM, Waters AJ, Wetter DW. Mechanisms underlying mindfulness-based addiction treatment versus cognitive behavioral therapy and usual care for smoking cessation. J Consult Clin Psychol 2017. [PMID: 28650195 DOI: 10.1037/ccp0000229] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine cognitive and affective mechanisms underlying mindfulness-based addiction treatment (MBAT) versus cognitive-behavioral therapy (CBT) and usual care (UC) for smoking cessation. METHOD Participants in the parent study from which data were drawn (N = 412; 54.9% female; 48.2% African American, 41.5% non-Latino White, 5.4% Latino, 4.9% other; 57.6% annual income <$30,000) were randomized to MBAT (n = 154), CBT (n = 155), or UC (n = 103). From quit date through 26 weeks postquit, participants completed measures of emotions, craving, dependence, withdrawal, self-efficacy, and attentional bias. Biochemically confirmed 7-day smoking abstinence was assessed at 4 and 26 weeks postquit. Although the parent study did not find a significant treatment effect on abstinence, mixed-effects regression models were conducted to examine treatment effects on hypothesized mechanisms, and indirect effects of treatments on abstinence were tested. RESULTS Participants receiving MBAT perceived greater volitional control over smoking and evidenced lower volatility of anger than participants in both other treatments. However, there were no other significant differences between MBAT and CBT. Compared with those receiving UC, MBAT participants reported lower anxiety, concentration difficulties, craving, and dependence, as well as higher self-efficacy for managing negative affect without smoking. Indirect effects of MBAT versus UC on abstinence occurred through each of these mechanisms. CONCLUSIONS Whereas several differences emerged between MBAT and UC, MBAT and CBT had similar effects on several of the psychosocial mechanisms implicated in tobacco dependence. Results help to shed light on similarities and differences between mindfulness-based and other active smoking cessation treatments. (PsycINFO Database Record
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Affiliation(s)
- Claire Adams Spears
- Division of Health Promotion and Behavior, Georgia State University School of Public Health
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center
| | - Cai Wu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center
| | | | | | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
| | - Diana Stewart Hoover
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center
| | | | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center
| | - Andrew J Waters
- Department Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - David W Wetter
- Department of Population Health Sciences, University of Utah
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18
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Pinsker EA, Hennrikus DJ, Erickson DJ, Call KT, Forster JL, Okuyemi KS. Cessation-related weight concern among homeless male and female smokers. Prev Med Rep 2017; 7:77-85. [PMID: 28593127 PMCID: PMC5458131 DOI: 10.1016/j.pmedr.2017.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/14/2017] [Accepted: 05/15/2017] [Indexed: 11/05/2022] Open
Abstract
Concern about post-cessation weight gain is a barrier to making attempts to quit smoking; however, its effect on smoking cessation is unclear. In this study we examine cessation-related weight concern among the homeless, which hasn't been studied. Homeless males (n = 320) and females (n = 110) participating in a smoking cessation RCT in the Twin Cities, Minnesota from 2009 to 2011 completed surveys on cessation-related weight concern, smoking status, and components from the Behavioral Model for Vulnerable Populations. Generalized estimating equations were used to examine baseline predictors of cessation-related weight concern at baseline, the end of treatment, and 26-weeks follow-up. Logistic regression models were used to examine the relationship between cessation-related weight concern and smoking status at the end of treatment and follow-up. Females had higher cessation-related weight concern than males. Among males, older age, Black race, higher BMI, depression, and having health insurance were associated with higher cessation-related weight concern. Among females, nicotine dependence, greater cigarette consumption, indicating quitting is more important, older age of smoking initiation, and less support to quit from family were associated with higher cessation-related weight concern. In multivariate analyses, cessation-related weight concern decreased over time among females. Cessation-related weight concern wasn't associated with smoking cessation. Although several types of characteristics predicted cessation-related weight concern among males, only smoking characteristics predicted cessation-related weight concern among females. Given the small proportion of quitters in this study (8% of males and 5% of females), further research on the impact of cessation-related weight concern on smoking cessation among the homeless is warranted. Concern about post-quitting weight gain is higher among homeless females than males. In multivariate analyses, weight concern decreased over time among homeless females. Several types of variables predicted weight concern among homeless males. Only smoking characteristics predicted weight concern among homeless females. Weight concern was not associated with smoking cessation among the homeless.
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Affiliation(s)
- Erika Ashley Pinsker
- Minneapolis VA Health Care System, Center for Chronic Disease Outcomes Research, One Veterans Drive Minneapolis, MN 55417, USA.,University of Minnesota, Department of Medicine, 401 East River Parkway Suite 131, Minneapolis, MN 55455, USA
| | - Deborah Jane Hennrikus
- University of Minnesota, Division of Epidemiology and Community Health, 1300 S 2nd St., Minneapolis, MN 55455, USA
| | - Darin J Erickson
- University of Minnesota, Division of Epidemiology and Community Health, 1300 S 2nd St., Minneapolis, MN 55455, USA
| | - Kathleen Thiede Call
- University of Minnesota, Division of Health Policy & Management, 516 Delaware St. SE Suite 15-223, Minneapolis, MN 55455, USA
| | - Jean Lois Forster
- University of Minnesota, Division of Epidemiology and Community Health, 1300 S 2nd St., Minneapolis, MN 55455, USA
| | - Kolawole Stephen Okuyemi
- University of Minnesota, Program in Health Disparities Research, 717 Delaware St. SE Suite 166, Minneapolis, MN 55414, USA
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19
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Kolko RP, Emery RL, Cheng Y, Levine MD. Do Psychiatric Disorders or Measures of Distress Moderate Response to Postpartum Relapse Prevention Interventions? Nicotine Tob Res 2017; 19:615-622. [PMID: 28403471 DOI: 10.1093/ntr/ntw385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/15/2016] [Indexed: 11/13/2022]
Abstract
Introduction Most women who quit smoking during pregnancy will relapse postpartum. Interventions for sustained postpartum abstinence can benefit from understanding prenatal characteristics associated with treatment response. Given that individuals with psychiatric disorders or elevated depressive symptoms have difficulty quitting smoking and that increases in depressive symptoms prenatally are common, we examined the relevance of psychiatric diagnoses, prenatal depressive symptoms, and stress to postpartum relapse prevention intervention response. Methods Pregnant women (N = 300) who quit smoking during pregnancy received intervention (with specialized focus on mood, weight, and stress [STARTS] or a comparison [SUPPORT]) to prevent postpartum relapse. As previously published, nearly one-third and one-quarter of women achieved biochemically-confirmed sustained abstinence at 24- and 52-weeks postpartum, with no difference in abstinence rates between the interventions. Women completed psychiatric interviews and questionnaires during pregnancy. Smoking was assessed in pregnancy, and 24- and 52-weeks postpartum. Results Psychiatric disorders did not predict sustained abstinence or treatment response. However, treatment response was moderated by end-of-pregnancy depressive symptoms (χ2 = 9.98, p = .002) and stress (χ2 = 6.90, p = .01) at 24- and 52-weeks postpartum and remained significant after including covariates. Women with low distress achieved higher abstinence rates in SUPPORT than in STARTS (37% vs. 19% for depressive symptoms; 36% vs. 19% for stress), with no difference for women with high symptoms. Conclusions Prenatal depressive symptoms and stress predicted differential treatment efficacy in women with low symptoms, not in women with high symptoms. Diagnostic history did not predict treatment differences. Future research to address prenatal distress may help tailor postpartum relapse prevention interventions. Implications We examined prenatal history of psychiatric disorders and psychiatric distress as moderators of response to postpartum smoking relapse prevention intervention that either included or did not include added content on mood, stress, and weight concerns. For women with lower psychiatric distress, the added focus is not necessary, as these women achieved greater sustained abstinence in the less-intensive treatment. Understanding which women need which level of care to sustain abstinence can help allocate resources for all postpartum former smokers. These findings underscore the importance of perinatal symptom monitoring and promoting behavioral health more broadly in pregnant and postpartum women.
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Affiliation(s)
- Rachel P Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rebecca L Emery
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Yu Cheng
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Statistics, University of Pittsburgh, Pittsburgh, PA
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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20
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Damron KR. Review of the Relationships Among Psychosocial Stress, Secondhand Smoke, and Perinatal Smoking. J Obstet Gynecol Neonatal Nurs 2017; 46:325-333. [PMID: 28390924 DOI: 10.1016/j.jogn.2017.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To summarize and evaluate the recently published literature in which the relationships among psychosocial stress, smoking, and exposure to secondhand smoke during the perinatal period are examined, and to describe the characteristics and demographics of the samples. DATA SOURCES Electronic databases MEDLINE, Academic Search Complete, CINAHL, Psychology and Behavioral Sciences Collection, and PsychINFO. In addition, hand searches of reference lists supplemented the electronic search. STUDY SELECTION English language, peer-reviewed studies published between 2010 and 2015 on the relationships of self-reported or perceived stress, smoking, and secondhand smoke exposure during pregnancy and postpartum were included. Twenty-four studies met the inclusion criteria. DATA EXTRACTION Data that specified the relationships among smoking, stress, and secondhand smoke exposure during pregnancy and postpartum were extracted from the studies. A table matrix, available as supplemental material, to summarize the literature and sample characteristics and demographics was created. DATA SYNTHESIS Evidence from the included studies supported an association between psychosocial stress specific to pregnancy or from other sources and smoking or smoking relapse during pregnancy or in the postpartum period. In the studies in which it was included, exposure to secondhand smoke was cited as a barrier to abstinence. CONCLUSION It is probable that women who persistently smoke in pregnancy experience elevated stress. Further research with longitudinal designs and inclusion of secondhand smoke as a variable are needed.
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21
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Griffis H, Matone M, Kellom K, Concors E, Quarshie W, French B, Rubin D, Cronholm PF. Home visiting and perinatal smoking: a mixed-methods exploration of cessation and harm reduction strategies. BMC Public Health 2016; 16:764. [PMID: 27514836 PMCID: PMC4982407 DOI: 10.1186/s12889-016-3464-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022] Open
Abstract
Background Home visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied. Methods Mixed methods approach using a retrospective cohort of propensity score matched home visiting clients and local-area comparison women with first births between 2008–2014 in a large Northeast state. Multivariable logistic and linear regression estimated third trimester prenatal tobacco smoking cessation and reduction. Additionally, qualitative interviews were conducted with 76 home visiting clients. Results A program effect was seen for smoking cessation such that clients who smoked less than ten cigarettes per day and those who smoked 20 or more cigarettes per day during the first trimester were more likely to achieve third trimester cessation than comparison women (p <0.01 and p = 0.01, respectively). Only for heavy smokers (20 or more cigarettes during the first trimester) was there a significant reduction in number of cigarettes smoked by the third trimester versus comparison women (p = 0.01). Clients expressed the difficulty of cessation, but addressed several harm-reduction strategies including reducing smoking in the house and wearing a smoking jacket. Clients also described smoking education that empowered them to ask others to not smoke or adopt other harm reducing behaviors when around their children. Conclusions While a significant impact on smoking cessation was seen, this study finds a less-clear impact on smoking reduction among women in home visiting programs. As home visiting programs continue to expand, it will be important to best identify effective ways to support tobacco-related harm reduction within vulnerable families. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3464-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heather Griffis
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA.
| | - Meredith Matone
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA.,Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katherine Kellom
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA
| | - Erica Concors
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA
| | - William Quarshie
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin French
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David Rubin
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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22
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Abstract
Introduction: Smoking during pregnancy is associated with adverse outcomes. Tobacco cessation in the general population is associated with weight gain. Aims: We sought to compare gestational weight gain (GWG) in women who quit smoking during pregnancy with those who continued smoking and non-smokers in two countries with high smoking prevalence in pregnancy. Methods: This study uses baseline data from a brief cessation intervention clustered randomised controlled trial; data were collected from clinical records and through questionnaires at post-partum hospitalisations during October 2011–May 2012. Women had attended one of 20 selected clusters of publicly funded prenatal care clinics in Argentina and Uruguay. Self-reported cessation was verified biochemically. Results: Of 2636 pregnant women, 29.9% were smokers at the beginning of pregnancy; among them 41.9% quit and 58.1% continued smoking. Most women (60.7%) had a normal pre-pregnancy body mass index (BMI). Adjusted mean weight gain was higher in quitters than in continuing smokers and non-smokers. Cessation increased GWG by 2.4 kg (95% confidence interval 1.3–3.4) after adjusting by pre-pregnancy BMI and other confounders in comparison with women who continued smoking(p < 0.001). Conclusions: GWG was slightly higher in women who quit smoking at any time during pregnancy.
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23
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Jones M, Lewis S, Parrott S, Wormall S, Coleman T. Re-starting smoking in the postpartum period after receiving a smoking cessation intervention: a systematic review. Addiction 2016; 111:981-90. [PMID: 26990248 PMCID: PMC6680353 DOI: 10.1111/add.13309] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/18/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Abstract
AIMS In pregnant smoking cessation trial participants, to estimate (1) among women abstinent at the end of pregnancy, the proportion who re-start smoking at time-points afterwards (primary analysis) and (2) among all trial participants, the proportion smoking at the end of pregnancy and at selected time-points during the postpartum period (secondary analysis). METHODS Trials identified from two Cochrane reviews plus searches of Medline and EMBASE. Twenty-seven trials were included. The included trials were randomized or quasi-randomized trials of within-pregnancy cessation interventions given to smokers who reported abstinence both at end of pregnancy and at one or more defined time-points after birth. Outcomes were validated biochemically and self-reported continuous abstinence from smoking and 7-day point prevalence abstinence. The primary random-effects meta-analysis used longitudinal data to estimate mean pooled proportions of re-starting smoking; a secondary analysis used cross-sectional data to estimate the mean proportions smoking at different postpartum time-points. Subgroup analyses were performed on biochemically validated abstinence. RESULTS The pooled mean proportion re-starting at 6 months postpartum was 43% [95% confidence interval (CI) = 16-72%, I(2) = 96.7%] (11 trials, 571 abstinent women). The pooled mean proportion smoking at the end of pregnancy was 87% (95% CI = 84-90%, I(2) = 93.2%) and 94% (95% CI = 92-96%, I(2) = 88%) at 6 months postpartum (23 trials, 9262 trial participants). Findings were similar when using biochemically validated abstinence. CONCLUSIONS In clinical trials of smoking cessation interventions during pregnancy only 13% are abstinent at term. Of these, 43% re-start by 6 months postpartum.
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Affiliation(s)
- Matthew Jones
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Sarah Lewis
- Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Steve Parrott
- Department of Health SciencesUniversity of YorkYorkUK
| | - Stephen Wormall
- Division of Primary CareUniversity of NottinghamNottinghamUK
| | - Tim Coleman
- Division of Primary CareUniversity of NottinghamNottinghamUK
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24
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Levine MD, Cheng Y, Marcus MD, Kalarchian MA, Emery RL. Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial. JAMA Intern Med 2016; 176:443-52. [PMID: 26998789 PMCID: PMC7333234 DOI: 10.1001/jamainternmed.2016.0248] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Most women who quit smoking during pregnancy will relapse postpartum. Previous efforts to prevent postpartum relapse have been unsuccessful at increasing rates of sustained abstinence. OBJECTIVE To evaluate the relative efficacy of 2 different approaches to prevent postpartum smoking relapse. DESIGN, SETTING, AND PARTICIPANTS Pregnant women who recently had quit smoking were recruited before the end of pregnancy. Intervention sessions were conducted through a combination of telephone calls and in-person visits beginning at delivery and continuing through 24 weeks postpartum. Participants completed assessments at the prenatal baseline and at 12, 24, and 52 weeks postpartum. Participants were recruited between March 2008 and December 2012. The dates of the analysis were April 2014 to February 2015. INTERVENTIONS Women received postpartum-adapted, behavioral smoking relapse prevention intervention and were randomly assigned to an enhanced cognitive behavioral intervention that included additional specialized strategies and content focused on women's postpartum concerns about mood, stress, and weight (Strategies to Avoid Returning to Smoking [STARTS]) or a supportive, time and attention-controlled comparison (SUPPORT). Intervention began before delivery and continued through 24 weeks postpartum. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically confirmed sustained tobacco abstinence at 52 weeks postpartum. Secondary outcomes were self-reported mood, levels of perceived stress, and degree of concern about smoking-related weight gain. RESULTS The study cohort comprised 300 participants (150 randomly assigned to each group). Their mean (SD) age was 24.99 (5.65) years. Overall, 38.0% (114 of 300), 33.7% (101 of 300), and 24.0% (72 of 300) of the sample maintained abstinence at 12, 24, and 52 weeks' postpartum, respectively. There were no differences between the intervention groups in abstinence or time to relapse. Self-reported depressive symptoms and perceived stress significantly improved over time, and improvements were similar for both intervention groups. Women with more depressive symptoms and higher levels of perceived stress were more likely to relapse (hazard ratio, 1.02; 95% CI, 1.00-1.04; P = .04 for depressive symptoms and hazard ratio, 1.04; 95% CI, 1.01-1.07; P = .003 for stress). CONCLUSIONS AND RELEVANCE An intervention designed to address women's concerns about mood, stress, and weight did not differentially improve rates of sustained tobacco abstinence postpartum compared with a time and attention-controlled comparison. Women in STARTS and SUPPORT reported postpartum improvements in mood and stress, and the experience of fewer depressive symptoms and less perceived stress was related to sustained abstinence. Given that most pregnant quitters will relapse within 1 year postpartum and that postpartum smoking has negative health consequences for women and children, effective interventions that target postpartum mood and stress are needed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00757068.
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Affiliation(s)
- Michele D Levine
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yu Cheng
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania2Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania3Department of Psychiatry, University of Pitt
| | - Marsha D Marcus
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa A Kalarchian
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania4Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | - Rebecca L Emery
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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25
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Walker LO, Murphey CL, Nichols F. The Broken Thread of Health Promotion and Disease Prevention for Women During the Postpartum Period. J Perinat Educ 2016; 24:81-92. [PMID: 26957891 DOI: 10.1891/1058-1243.24.2.81] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Postpartum maternal health affects maternal functional status, future pregnancy outcomes, maternal chronic disease development, and infant health. After pregnancy, however, many mothers may find that they face gaps in care related to their health and caregiving roles. Research shows that they were unprepared, uninformed, and unsupported during the postpartum period as they struggle with physical and emotional symptoms, infant caregiving, breastfeeding concerns, and lifestyle adjustments. Limited follow-up after a diagnosis of gestational hypertension or gestational diabetes and screening for postpartum depression are additional gaps in preventive and supportive care. Integrative reviews revealed modest efficacy and limitations of recent postpartum health promotion and disease prevention interventions. System, clinical, and community strategies are identified to address these gaps in women's postpartum health services.
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26
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Abstract
This integrative review provides an overview of nicotine dependence measures used with perinatal women and an evaluation of their psychometric properties. Fifty-five articles that met inclusion and exclusion criteria were identified from five different databases. Most of the studies used the Fagerström Test for Nicotine Dependence (FTND). Other approaches included diagnostic tests, the Wisconsin Inventory of Smoking Dependence Motives (WISDM), the Tobacco Dependence Screener, and single-item measures. This review indicated that the FTND may not be the best option for measuring nicotine dependence in this population. The WISDM is a newer instrument that has excellent psychometric properties and captures nonnicotinic dimensions of nicotine dependence relevant to women. Future research is needed to assess its reliability in the perinatal population. Other recommendations from this review include the use of biomarker validation, thorough psychometric reporting on nicotine dependence instruments, and the use of multiple instruments to maximize comparability between nicotine dependence instruments.
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27
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Walker LO, Xie B, Hendrickson SG, Sterling BS. Behavioral and Psychosocial Health of New Mothers and Associations With Contextual Factors and Perceived Health. J Obstet Gynecol Neonatal Nurs 2016; 45:3-16. [DOI: 10.1016/j.jogn.2015.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 01/12/2023] Open
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28
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Micali N, Stemann Larsen P, Strandberg-Larsen K, Nybo Andersen AM. Size at birth and preterm birth in women with lifetime eating disorders: a prospective population-based study. BJOG 2015; 123:1301-10. [DOI: 10.1111/1471-0528.13825] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/27/2022]
Affiliation(s)
- N Micali
- Behavioural and Brain Sciences Unit; Institute of Child Health; UCL; London UK
- Department of Psychiatry and Mindich Child Health and Development Institute; Icahn Medical School at Mount Sinai; New York NY USA
| | - P Stemann Larsen
- Section of Social Medicine; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - K Strandberg-Larsen
- Section of Social Medicine; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - A-M Nybo Andersen
- Section of Social Medicine; Department of Public Health; University of Copenhagen; Copenhagen Denmark
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29
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Walker LO, Gao J, Xie B. Postpartum Psychosocial and Behavioral Health: A Systematic Review of Self-Administered Scales Validated for Postpartum Women in the United States. Womens Health Issues 2015; 25:586-600. [DOI: 10.1016/j.whi.2015.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 05/09/2015] [Accepted: 05/12/2015] [Indexed: 11/11/2022]
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Slane JD, Levine MD. Association of Restraint and Disinhibition to Gestational Weight Gain among Pregnant Former Smokers. Womens Health Issues 2015; 25:390-5. [PMID: 26048757 DOI: 10.1016/j.whi.2015.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 03/01/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gaining excessive weight during pregnancy is associated with immediate maternal and fetal complications as well as longer term obesity. Prepregnancy body mass index, age, and smoking cessation have been related to gestational weight gain (GWG); however, less is known about how eating behaviors, that may be amenable to modification and have been related to weight gain outside of pregnancy, affect GWG. METHODS The present study evaluated the relationship of dietary restraint and disinhibition to GWG in a sample of women (n=248) who quit smoking before or early in pregnancy. Women self-reported height and prepregnancy weight during their third trimester. GWG was calculated by subtracting prepregnancy weight from third trimester weight. The Three-Factor Eating Questionnaire assessed restraint and disinhibition. RESULTS Average GWG was 14.60 (±7.64) kg and 47% of women had a GWG greater than the Institute of Medicine recommendations. Linear regression models were used to examine restraint and disinhibition as correlates of GWG, and multinomial logistic regressions were utilized to determine whether eating behaviors were associated with inadequate or excessive GWG. Restraint was associated positively with total GWG, but disinhibition was not associated with GWG. Thus, conscious attempts to restrict intake were associated with GWG beyond the influence of covariates. CONCLUSION These findings highlight the potential influence of modifiable eating behaviors on GWG and demonstrate the need for additional research to determine how these behaviors relate to GWG over the course of pregnancy.
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Affiliation(s)
- Jennifer D Slane
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Suzuki K, Sato M, Zheng W, Shinohara R, Yokomichi H, Yamagata Z. Childhood growth trajectories according to combinations of pregestational weight status and maternal smoking during pregnancy: a multilevel analysis. PLoS One 2015; 10:e0118538. [PMID: 25680116 PMCID: PMC4332663 DOI: 10.1371/journal.pone.0118538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022] Open
Abstract
Pregestational weight status and maternal smoking during pregnancy are significantly associated with fetal and childhood growth. However, few studies have examined associations between childhood growth and combinations of these factors using multilevel analysis. This study aimed to describe differences in childhood growth trajectories according to these combinations, using data from a prospective cohort study in Japan. The study participants were 1,973 women and their singletons, who were born between April 1, 1991 and March 31, 2003. Children were categorized according to whether they were born to normal-weight, nonsmoking mothers (NN); normal-weight, smoking mothers (NS); underweight, nonsmoking mothers (UN); underweight, smoking mothers (US); overweight, nonsmoking mothers (ON); or overweight, smoking mothers (OS). Birth weight and anthropometric data were collected from 1,965 children at birth (99.6%), 1,655 aged 3 (83.9%), 1,527 aged 5 (77.4%), 1,497 aged 7–8 (75.9%), and 1,501 aged 9–10 (76.1%). Multilevel analysis examining both individual and age as different level variables according to sex was used to describe the trajectories of body mass index z scores for statistical analyses. Although children of the OS group were the leanest at birth, their body mass indices had increased rapidly by 3 years of age. Moreover, body mass index was also likely to increase in boys in the NS and ON groups. A different trend was observed in girls. Body mass index decreased from 5 years of age in girls in the US group. There were no remarkable differences in body mass index trajectories between children in the other groups. In conclusion, childhood growth trajectories differed according to combinations of pregestational weight status and maternal smoking during pregnancy. Further, there were sex-related differences in the associations between childhood growth and factor combinations.
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Affiliation(s)
- Kohta Suzuki
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
- * E-mail:
| | - Miri Sato
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Wei Zheng
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
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Wen KY, Miller SM, Roussi P, Belton TD, Baman J, Kilby L, Hernandez E. A content analysis of self-reported barriers and facilitators to preventing postpartum smoking relapse among a sample of current and former smokers in an underserved population. HEALTH EDUCATION RESEARCH 2015; 30:140-151. [PMID: 25099776 PMCID: PMC4296888 DOI: 10.1093/her/cyu048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 07/15/2014] [Indexed: 06/03/2023]
Abstract
To characterize the barriers and facilitators thatprevent postpartum relapse and maintain smoking abstinence among a socioeconomically underserved population, recruited through Philadelphia-area women, infants, and children clinics, in-person interviews were conducted with 30 women who had quit smoking for one or more pregnancies in the past 3 years to retrospectively describe their attempts to remain abstinent during the postpartum period. Responses were analysed using the constructs from the Cognitive-Social Health Information Processing model, which identifies the cognitive, affective and behavioral factors involved in goal-oriented self-regulatory actions, in the context of a vulnerable population of women. Motherhood demands were a significant source of relapse stress. Stresses associated with partner and family relationships also contributed to relapse. The presence of other smokers in the environment was mentioned by many women in our sample as affecting their ability to remain smoke-free postpartum. Participants reported four main strategies that helped them to successfully cope with postpartum cravings and relapses, including being informed of smoking risks, maintaining goal-oriented thoughts, focusing on their concerns about the baby's health and receiving positive social support from families and friends. Results provide guidance for the design of smoking relapse interventions that may address the unique stressors reported by underserved postpartum women.
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Affiliation(s)
- Kuang-Yi Wen
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Suzanne M Miller
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Pagona Roussi
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Tanisha D Belton
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Jayson Baman
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Linda Kilby
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Enrique Hernandez
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
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Beebe LA, Bush T. Post-cessation weight concerns among women calling a state tobacco quitline. Am J Prev Med 2015; 48:S61-4. [PMID: 25528710 DOI: 10.1016/j.amepre.2014.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obese and overweight women who smoke are more likely to be concerned about weight gain following cessation, impacting ability to quit and relapse. PURPOSE To determine differences in weight concerns for underweight, normal weight, overweight, and obese female smokers by race/ethnicity. METHODS From March to November 2008, female adult tobacco users calling the Oklahoma Tobacco Helpline were asked questions to determine the prevalence of obesity and concern for cessation-related weight gain. A score of 50 or greater, where 0=not at all concerned and 100=very concerned, on one of two weight concerns questions defined the outcome. BMI was calculated from self-reported height and weight. For the current analyses in 2013, race, ethnicity, age, education, marital status, and tobacco use history were examined as covariates. Multiple logistic regression was used to calculate ORs and 95% CIs. RESULTS A significant interaction between race and BMI was observed; thus, separate models were created for white (n=3,579); black (n=330); American Indian (n=441); and Hispanic (n=125) women. BMI was independently associated with weight concerns among all racial/ethnic groups, but the strength of the association varied. For black and Hispanic women, there was a particularly strong association between BMI and weight concerns among obese women (OR=9.55, 95% CI=5.05, 18.07, and OR=8.46, 95% CI=2.57, 27.83, respectively), although sample sizes were small. CONCLUSIONS State quitlines should consider tailoring promotional efforts and treatment protocols to include concerns about weight gain, especially for obese African American and Hispanic smokers.
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Affiliation(s)
- Laura A Beebe
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Terry Bush
- Alere Wellbeing, Inc. Seattle, Washington
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Tuovinen EL, Saarni SE, Kinnunen TH, Haukkala A, Jousilahti P, Patja K, Kaprio J, Korhonen T. Associations of Weight Concerns With Self-Efficacy and Motivation to Quit Smoking: A Population-Based Study Among Finnish Daily Smokers. Nicotine Tob Res 2014; 17:1134-41. [PMID: 25542916 DOI: 10.1093/ntr/ntu277] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/11/2014] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Concerns about weight gain occurring after smoking cessation may affect motivation and self-efficacy towards quitting smoking. We examined associations of smoking-specific weight concerns with smoking cessation motivation and self-efficacy in a population-based cross-sectional sample of daily smokers. METHODS Six-hundred biochemically verified (blood cotinine) current daily smokers comprising 318 men and 282 women aged 25-74 years, were studied as part of the National FINRISK (Finnish Population Survey on Risk Factors on Chronic, Noncommunicable Diseases) study and its DIetary, Lifestyle and Genetic factors in the development of Obesity and Metabolic syndrome (DILGOM) sub-study that was conducted in Finland in 2007. Self-reported scales were used to assess weight concerns, motivation and self-efficacy regarding the cessation of smoking. Multiple regression analyses of concerns about weight in relation to motivation and self-efficacy were conducted with adjustments for sex, age (years), body mass index (BMI, [kg/m(2)]), physical activity (times per week), and further controlled for nicotine dependence (Fagerström Test for Nicotine Dependence). RESULTS Higher levels of weight concerns were associated with lower self-efficacy (β = -0.07, p < .001) after adjusting for sex and age. The association remained after additional adjustment for BMI and physical activity (β = -0.07, p < .001). After further controlling for nicotine dependence the association became weaker but remained significant (β = -0.04, p = .02). There were no statistically significant associations between concerns about weight and motivation for smoking cessation (β = 0.02, p = 0.16). CONCLUSIONS These cross-sectional population-based data do not support earlier findings that suggest that smokers with high levels of weight concerns are less motivated to quit smoking. Our data suggest that daily smokers who are highly concerned about weight may have lower self-efficacy for cessation of smoking.
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Affiliation(s)
| | - Suoma E Saarni
- Psychiatry Division, Turku University Central Hospital, Turku, Finland; Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland
| | - Taru H Kinnunen
- Department of Oral Health Policy and Epidemiology, Harvard Medical School, Boston, MA; Behavioral Science Consulting, Hopkinton, MA
| | - Ari Haukkala
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Kristiina Patja
- Independent Researcher, Association for Continuous Medical Education in Finland, Pro Medico, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland
| | - Tellervo Korhonen
- Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Wen KY, Miller SM, Kilby L, Fleisher L, Belton TD, Roy G, Hernandez E. Preventing postpartum smoking relapse among inner city women: development of a theory-based and evidence-guided text messaging intervention. JMIR Res Protoc 2014; 3:e20. [PMID: 24698804 PMCID: PMC4004157 DOI: 10.2196/resprot.3059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/27/2014] [Accepted: 02/20/2014] [Indexed: 11/15/2022] Open
Abstract
Background Underserved women are at high risk for smoking relapse after childbirth due to their unique socioeconomic and postpartum stressors and barriers. Mobile text messaging technology allows delivery of relapse prevention programs targeted to their personal needs over time. Objective To describe the development of a social-cognitive theory-based and evidence-guided text messaging intervention for preventing postpartum smoking relapse among inner city women. Methods Guided by the cognitive-social health information processing framework, user-centered design, and health communication best practices, the intervention was developed through a systematic process that included needs assessment, followed by an iterative cycling through message drafting, health literacy evaluation and rewriting, review by target community members and a scientific advisory panel, and message revision, concluding with usability testing. Results All message content was theory-grounded, derived by needs assessment analysis and evidence-based materials, reviewed and revised by the target population, health literacy experts, and scientific advisors. The final program, “Txt2Commit,” was developed as a fully automated system, designed to deliver 3 proactive messages per day for a 1-month postpartum smoking relapse intervention, with crave and lapse user-initiated message functions available when needed. Conclusions The developmental process suggests that the application of theory and best practices in the design of text messaging smoking cessation interventions is not only feasible but necessary for ensuring that the interventions are evidence based and user-centered.
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Affiliation(s)
- Kuang-Yi Wen
- Fox Chase Cancer Center/Temple University Health System, Cancer Prevention and Control, Philadelphia, PA, United States
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Sieminska A, Jassem E. The many faces of tobacco use among women. Med Sci Monit 2014; 20:153-62. [PMID: 24487778 PMCID: PMC3915001 DOI: 10.12659/msm.889796] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/21/2013] [Indexed: 12/14/2022] Open
Abstract
Smoking is still considered to be mainly a male problem. However, it is estimated that there are approximately 250 million women worldwide who smoke cigarettes and millions more women who use smokeless tobacco products. This article addresses the many facets of tobacco use among women. The aim of the paper is to increase recognition among clinicians and researchers of the specific characteristics of female tobacco use. Together with providing epidemiological data on the distribution of tobacco use among women and data from population-based analyses on sociocultural factors that influence it, the article presents tobacco use during pregnancy as a particularly important public health problem. Further, the article points out sex-related differences (ie, physiological, psychological, or behavioral) between male and female tobacco use. A special focus is on the important role of ovarian hormones. Adverse effects of tobacco use to women and their children as well as tobacco-related morbidities and comorbidities are presented, and women's greater susceptibility to tobacco constituents as compared to men is stressed. Awareness of these differences can contribute to improvement of the effectiveness of smoking cessation programs addressed both to the specific female population and to an individual smoking woman.
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Simmons VN, Sutton SK, Quinn GP, Meade CD, Brandon TH. Prepartum and postpartum predictors of smoking. Nicotine Tob Res 2013; 16:461-8. [PMID: 24203933 DOI: 10.1093/ntr/ntt177] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Reduction of smoking during pregnancy and in the postpartum period remains a public health priority. This study tested whether variables (demographic, pregnancy related, emotional, and smoking related) assessed in abstinent women during their pregnancy predicted resumed smoking at 1 month and 1 year postpartum. Additionally, pregnancy-related and smoking-related variables obtained in the immediate postpartum period were examined as predictors of smoking at 1 year postpartum. METHODS Participants were pregnant women in their second and third trimester (N = 504) who enrolled in a randomized controlled trial of a smoking relapse-prevention intervention. Multivariate regression analyses were conducted with baseline data collected during pregnancy and follow-up assessments completed at 1 month and 12 months postpartum. RESULTS Independent predictors of smoking at 1 month postpartum included not intending to remain abstinent, lower quitting confidence, the presence of other household smokers, and not planning to breast feed. Smoking at 12 months postpartum was predicted by only not intending to remain abstinent and having a partner who maintained his or her smoking rate. In contrast, when assessed at 1 month postpartum, smoking at 12 months was predicted by current smoking status and lower quitting confidence. CONCLUSIONS Baseline variables measured during pregnancy differentially predicted early versus late smoking status. After delivery, the best predictor of later smoking status was current smoking status, reinforcing the need to focus on preventing early postpartum relapse. The importance of quitting confidence, or self-efficacy, was also reinforced. Findings may be useful for screening women at risk of relapse and targeting interventions to key variables.
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Affiliation(s)
- Vani Nath Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, FL
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Levine MD, Marcus MD, Kalarchian MA, Cheng Y. Strategies to Avoid Returning to Smoking (STARTS): a randomized controlled trial of postpartum smoking relapse prevention interventions. Contemp Clin Trials 2013; 36:565-73. [PMID: 24140455 PMCID: PMC3878443 DOI: 10.1016/j.cct.2013.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/09/2013] [Accepted: 10/13/2013] [Indexed: 10/26/2022]
Abstract
The majority of women who quit smoking during pregnancy relapse postpartum and many experience increased depressive symptoms and concerns about body shape and weight. Given the relationship of weight concerns and negative mood to smoking relapse, interventions designed to address the postpartum experience are indicated. However, there are several challenges to research with postpartum women. We describe the rationale of a randomized controlled trial of postpartum smoking relapse prevention intervention and discuss methods to address the specific challenges to recruiting, retaining and conducting health behavior interventions among postpartum former smokers. Pregnant women who had quit smoking for at least one month prior to the 34 week of pregnancy and who were motivated to stay quit postpartum were recruited. Women were randomized either to a postpartum specific intervention designed to address concerns about mood, stress and weight using cognitive-behavioral techniques or to a support-only condition designed to control for time and attention. Intervention continues through six months postpartum and women complete follow-up assessments at 12-, 24- and 52-weeks after delivery. Women (n=300) who had quit smoking as a result of pregnancy were recruited and are being followed. The intervention described in this report is designed to address stress, negative mood and concerns about weight that mediate smoking relapse postpartum to sustain abstinence and improve maternal and infant health.
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Affiliation(s)
- Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
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Cumulative poor psychosocial and behavioral health among low-income women at 6 weeks postpartum. Nurs Res 2013; 62:233-42. [PMID: 23817281 DOI: 10.1097/nnr.0b013e31829499ac] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND During the postpartum period, women may experience unfavorable psychosocial and behavioral health in multiple domains with adverse effects on parenting and maternal and infant health. Yet, little is known about the accumulation of poor health across the domains of depressive symptoms; body image; diet and physical activity; substance use including smoking and alcohol; and general self-care at 6 weeks postpartum, the usual end of maternity care. OBJECTIVES The aims of this study were to evaluate relationships among the domains comprising psychosocial and behavioral health and to examine the distribution and risk factors associated with cumulative poor psychosocial and behavioral health at 6 weeks postpartum. METHODS This study was a secondary analysis of cumulative poor health assessed by self-report scales for depressive symptoms, body image dissatisfaction, diet and exercise, substance use, and general self-care among 419 low-income White, African American, and Hispanic women at 6 weeks postpartum. Multivariable Poisson and logistic regression were used in key analyses. RESULTS The correlation among psychosocial and behavioral domains had a range of r = .50-.00. In this sample of women, 45% had two or more domains in which they had poor health. The model testing risk factors for cumulative poor health was significant (likelihood ratio chi-square = 39.26, df = 11, p < 0.05), with two significant factors: not exclusively breastfeeding (odds ratio [OR] = 1.459, 95% confidence interval [CI] [1.119, 1.901]) and Hispanic ethnicity (OR = 0.707, 95% CI [0.582, 0.858], psuedo-R = .029). Within individual domains, significant risk factors (body mass index, not exclusively breastfeeding, ethnicity, education level, and parity) varied by domain. DISCUSSION Many low-income women postpartum have poor psychosocial and behavioral health in multiple domains, which constitute areas for health promotion and early disease prevention.
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Yasuda T, Ojima T, Nakamura M, Nagai A, Tanaka T, Kondo N, Suzuki K, Yamagata Z. Postpartum smoking relapse among women who quit during pregnancy: Cross-sectional study in Japan. J Obstet Gynaecol Res 2013; 39:1505-12. [PMID: 23875711 DOI: 10.1111/jog.12098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 02/01/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Takako Yasuda
- Department of Community Health and Preventive Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Akiko Nagai
- Department of Public Policy, Human Genome Center, The Institute of Medical Science; The University of Tokyo; Tokyo Japan
| | - Taichiro Tanaka
- Department of Environmental and Occupational Health, Faculty of Medicine; Toho University; Tokyo Japan
| | - Naoki Kondo
- Department of Health Economics and Epidemiology Research, School of Public Health; The University of Tokyo; Tokyo Japan
| | - Kohta Suzuki
- Interdisciplinary Graduate School of Medicine and Engineering; University of Yamanashi; Chuo, Yamanashi Japan
| | - Zentaro Yamagata
- Interdisciplinary Graduate School of Medicine and Engineering; University of Yamanashi; Chuo, Yamanashi Japan
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Satoh A, Kitamiya C, Yaegashi Y, Ohse F, Lee S, Kishi C, Menzawa K, Sasaki H. Influence of smoking on postpartum depression in Japan. Health (London) 2013. [DOI: 10.4236/health.2013.58170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Correa-Fernández V, Ji L, Castro Y, Heppner WL, Vidrine JI, Costello TJ, Mullen PD, Cofta-Woerpel L, Velasquez MM, Greisinger A, Cinciripini PM, Wetter DW. Mediators of the association of major depressive syndrome and anxiety syndrome with postpartum smoking relapse. J Consult Clin Psychol 2012; 80:636-48. [PMID: 22390410 DOI: 10.1037/a0027532] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Based on conceptual models of addiction and affect regulation, this study examined the mechanisms linking current major depressive syndrome (MDS) and anxiety syndrome (AS) to postpartum smoking relapse. METHOD Data were collected in a randomized clinical trial from 251 women who quit smoking during pregnancy. Simple and multiple mediation models of the relations of MDS and AS with postpartum relapse were examined using linear regression, continuation ratio logit models, and a bootstrapping procedure to test the indirect effects. RESULTS Both MDS and AS significantly predicted postpartum smoking relapse. After adjusting for MDS, AS significantly predicted relapse. However, after adjusting for AS, MDS no longer predicted relapse. Situationally based self-efficacy, expectancies of controlling negative affect by means other than smoking, and various dimensions of primary and secondary tobacco dependence individually mediated the effect of both MDS and AS on relapse. In multiple mediation models, self-efficacy in negative/affective situations significantly mediated the effect of MDS and AS on relapse. CONCLUSIONS The findings underscore the negative impact of depression and anxiety on postpartum smoking relapse and suggest that the effects of MDS on postpartum relapse may be largely explained by comorbid AS. The current investigation provided mixed support for affect regulation models of addiction. Cognitive and tobacco dependence-related aspects of negative and positive reinforcement significantly mediated the relationship of depression and anxiety with relapse, whereas affect and stress did not. The findings emphasize the unique role of low agency with respect to abstaining from smoking in negative affective situations as a key predictor of postpartum smoking relapse.
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Affiliation(s)
- Virmarie Correa-Fernández
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1402, USA.
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Psaros C, Pajolek H, Park ER. The role of negative affect management in postpartum relapse to smoking. Arch Womens Ment Health 2012; 15:15-20. [PMID: 22194083 DOI: 10.1007/s00737-011-0250-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 12/13/2011] [Indexed: 10/14/2022]
Abstract
The aim of this study was to explore the role of affect management in postpartum relapse to smoking. Between January and October 2005, 65 women who smoked prior to pregnancy but not during the last month of pregnancy were recruited from Brigham and Women's Hospital in Boston, MA, and followed for 24 weeks. Surveys administered at baseline, 2, 6, 12, and 24 weeks postpartum assessed smoking status and symptoms of depression (Beck Depression Inventory, BDI) and anxiety (Beck Anxiety Inventory, BAI). Qualitative interviews were conducted when women relapsed or achieved an elevated BDI or BAI score. Elevated BDI or BAI scores did not predict relapse, suggesting that symptoms that make women vulnerable to relapse may not be fully captured by these instruments. Women described feelings of anger or frustration as part of the relapse experience. Women with elevated BDI or BAI scores who did not relapse were more likely to normalize their mood symptoms as part of the postpartum experience and described more adaptive and active coping strategies. Interventions designed to prevent postpartum relapse to smoking may need to target a broader range of negative affect and mood management strategies to increase the likelihood of efficacy.
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Affiliation(s)
- Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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Levine MD, Cheng Y, Marcus MD, Kalarchian MA. Relapse to smoking and postpartum weight retention among women who quit smoking during pregnancy. Obesity (Silver Spring) 2012; 20:457-9. [PMID: 22076594 PMCID: PMC4076786 DOI: 10.1038/oby.2011.334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Postpartum weight retention contributes to obesity risk in women. Given that most women who quit smoking as a result of pregnancy will resume smoking within 6 months postpartum and that there is a robust association between smoking and weight, we sought to evaluate postpartum weight retention as a function of postpartum smoking status among women who had quit smoking during pregnancy. Women (N = 183) with biochemically confirmed cigarette abstinence at the end of pregnancy were recruited between February 2003 and November 2006. Women self-reported demographic information and weight before pregnancy. Smoking status and weight were documented at the end of pregnancy and at 6, 12, and 24 weeks postpartum. Breastfeeding was reported at 6 weeks postpartum. Differences in weight retention by relapse status at each assessment were evaluated. To examine weight retention in the presence of conceptually relevant covariates, mixed models with log-transformed weight data were used. At 24 weeks postpartum, 34.6% of women remained abstinent. Women who remained abstinent throughout the 24-week period retained 4.7 ± 2.1 kg more than did women who had relapsed by 6 weeks postpartum, P = 0.03. This difference in postpartum weight retention was significant after controlling for relevant covariates (age, race, breastfeeding, and pregravid BMI). Resumption of smoking within the first 6 weeks following childbirth is associated with decreased postpartum weight retention, even after controlling for breastfeeding and pregravid weight. Interventions to sustain smoking abstinence postpartum might be enhanced by components designed to minimize weight retention.
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Affiliation(s)
- Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Adams CE, Baillie LE, Copeland AL. The Smoking-Related Weight and Eating Episodes Test (SWEET): development and preliminary validation. Nicotine Tob Res 2011; 13:1123-31. [PMID: 21849410 DOI: 10.1093/ntr/ntr162] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Many smokers believe that smoking helps them to control their weight, and concerns about weight gain can interfere with smoking cessation. As researchers typically assess general weight concerns, a measure specific to smoking-related weight concerns is needed. METHODS The Smoking-related Weight and Eating Episodes Test (SWEET) was created by generating items from 4 content domains: Hunger, Craving, Overeating, and Body Image. Female undergraduate smokers (N = 280) rated their postcessation weight gain concern and completed the SWEET, Fagerström Test for Nicotine Dependence, Brief Smoking Consequences Questionnaire-Adult, Eating Attitudes Test (EAT)-26, Bulimia Test-Revised (BULIT-R), and Body Shape Questionnaire. RESULTS Factor analysis of the initial items suggested a 4-factor solution, suggesting 4 subscales: Smoking to suppress appetite, smoking to prevent overeating, smoking to cope with body dissatisfaction, and withdrawal-related appetite increases. Based on these results, the SWEET subscales were revised and shortened. The resulting 10-item SWEET showed excellent internal consistency (total α = .94; mean α = .86) and evidence of validity by predicting smoking frequency, eating pathology, and body image concerns (ps < .05). Smoking frequency, eating pathology, and body image concerns were significantly predicted by the SWEET while controlling for existing measures of postcessation weight gain concern. CONCLUSIONS The SWEET appears to be a reliable and valid measure of tendencies to smoke in response to body image concern and nicotine withdrawal and as a way to control appetite and overeating.
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Affiliation(s)
- Claire E Adams
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA.
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