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Gregory EF, Wright CS, Matone M, Rubin DM, Lorch SA. Support for Self-Management and Prenatal Health Behavior Change: Implications for Pediatric Promotion of Interconception Care. Glob Pediatr Health 2018; 5:2333794X18765368. [PMID: 29623289 PMCID: PMC5882042 DOI: 10.1177/2333794x18765368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/16/2022] Open
Abstract
Pediatricians increasingly endorse a dual generation approach to health, in which parental health behaviors are recognized as critical to promoting child health. Positive parental behaviors often emerge during pregnancy, for reasons that remain incompletely described. We surveyed mothers in the immediate postpartum period to identify beliefs about health behavior change and characteristics of prenatal care associated with successful change. Sampling at a tertiary care hospital captured an English-speaking adult population with healthy infants. Respondents (n = 225) were predominantly non-Hispanic Black (64%) and Medicaid insured (44%). Most (71%) reported successful behavior change during pregnancy. Of those reporting change, 91% intended to sustain behaviors postnatally. Most believed that sustained change was important for their own health (94%) and their infant’s health (93%). In logistic regression, support for self-management was associated with prenatal health behavior change (odds ratio = 1.64, 95% confidence interval = 1.09-2.46). Continued support for self-management by pediatricians may benefit long-term family health.
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Affiliation(s)
- Emily F Gregory
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | | | - Meredith Matone
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - David M Rubin
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Scott A Lorch
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
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Schoenaker DAJM, Ploubidis GB, Goodman A, Mishra GD. Factors across the life course predict women's change in smoking behaviour during pregnancy and in midlife: results from the National Child Development Study. J Epidemiol Community Health 2017; 71:1137-1144. [PMID: 28983062 DOI: 10.1136/jech-2017-209493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/07/2017] [Accepted: 09/16/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tobacco smoking before, during and after pregnancy remains one of the few preventable factors associated with poor health outcomes for mothers and their children. We investigate predictors across the life course for change in smoking behaviour during pregnancy and whether this change predicts smoking status in midlife. METHODS Data were from the National Child Development Study (1958 British birth cohort). We included female cohort members who reported a first pregnancy up to age 33 years. Among 1468 women who smoked before pregnancy, we examined predictors reported in childhood (age 11 years), adolescence (age 16 years) and early adulthood (age 23 years) of change in smoking behaviour from 12 months before to during pregnancy using log-binomial regression. The association between change in smoking behaviour during pregnancy and smoking status in midlife (age 55 years) was examined while adjusting for predictors across the life course. RESULTS Among prepregnancy smokers (39%), 26% reduced and 35% quit smoking during pregnancy. Parental smoking and lower social class during childhood, and early adulthood lower social class, depression, early smoking initiation, high smoking intensity, living with a smoker, no pregnancy planning and early motherhood were associated with lower probability of smoking reduction or cessation in pregnancy. Compared with women who smoked before and during pregnancy, women who reduced or quit were two times more likely to be non-smoker at age 55 years (95% CI 1.76 to 2.20). CONCLUSIONS Findings from this population-based birth cohort study lend support for smoking cessation strategies that target those at risk at various stages across the life course.
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Affiliation(s)
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL - Instituteof Education, University College London, London, UK
| | - Alissa Goodman
- Centre for Longitudinal Studies, UCL - Instituteof Education, University College London, London, UK
| | - Gita D Mishra
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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Smoking during pregnancy in the United States, 2005-2014: The role of depression. Drug Alcohol Depend 2017; 179:159-166. [PMID: 28783546 PMCID: PMC5635833 DOI: 10.1016/j.drugalcdep.2017.06.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite success of public health-oriented tobacco control programs in lowering the smoking prevalence over the past several decades, it is unclear whether similar reductions in smoking have been experienced among pregnant women, especially in vulnerable groups such as those with major depression and/or lower socioeconomic status. OBJECTIVES The purpose of this study is to examine the relationship between major depressive episode (MDE) and smoking among pregnant women overall, and by demographics and to estimate changes in the prevalence of cigarette smoking among pregnant women with and without MDE from 2005 to 2014. STUDY DESIGN Cigarette use among pregnant women with and without MDE was examined using logistic regression models in the National Survey on Drug Use and Health. RESULTS Prenatal smoking is more common among pregnant women with, compared to without, MDE (32.5% vs. 13.0%; (adjusted OR=2.50 (1.85, 3.40)), and greater disparities were revealed when also considering income, education and race. Over time, smoking during pregnancy increased significantly among women with MDE (35.9% to 38.4%; p=0.02)) and showed a decreasing trend among women without MDE (12.5% to 9.1%; p=0.07) from 2005 to 2014. CONCLUSIONS Over the past decade, smoking during pregnancy has increased among women experiencing a major depressive episode and is over four times more common among pregnant women with, than without, MDE. Disparities in smoking during pregnancy by MDE status and socioeconomic subgroups appear substantial. Given the multitude of risks associated with both MDE and smoking during the prenatal period, more work targeting this vulnerable and high-risk group is needed.
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Goodwin RD, Cheslack-Postava K, Nelson DB, Smith PH, Hasin DS, Janevic T, Bakoyiannis N, Wall MM. Serious Psychological Distress and Smoking During Pregnancy in the United States: 2008-2014. Nicotine Tob Res 2017; 19:605-614. [PMID: 28403468 PMCID: PMC5441894 DOI: 10.1093/ntr/ntw323] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The current study examined the relationship between acute (past 30 day) and recent (past year but not past 30 day) serious psychological distress (SPD) and smoking during pregnancy among women in the United States overall, stratified by demographic characteristics, and described the change in the prevalence of prenatal smoking among women with and without SPD, from 2008 to 2014. METHODS Data were drawn from the National Survey on Drug Use and Health (NSDUH), an annual cross-sectional study of US persons aged 12 and over. SPD and smoking in the past 30 days among pregnant women, aged 18 and older, were examined using logistic regression models. Heterogeneity in this association by demographic characteristics, trends over time, and level of cigarette consumption was also examined. RESULTS Prenatal smoking was common. Almost 40% of pregnant women with acute SPD reported smoking, 23% of pregnant women with recent SPD smoked, and 11.7% of pregnant women without recent SPD smoked. No significant change was found in the prevalence of prenatal smoking from 2008 to 2014 in any of these groups. Robust relationships were found between acute (OR = 5.05 [3.64-6.99]) and recent SPD (OR = 2.37 [1.74-3.24]) and smoking; these findings remained after adjusting for demographics. CONCLUSIONS SPD and smoking during pregnancy are strongly associated; this relationship is present across all sociodemographic groups and the prevalence of smoking in pregnancy has remained relatively unchanged over the past decade both in the presence and absence of SPD. IMPLICATIONS SPD and smoking in pregnancy are robustly linked; the prevalence of smoking in pregnancy is extremely high in women with SPD. Screening women with mental health problems for prenatal smoking, as well as screening pregnant smokers for mental health problems, seems warranted and may assist more women in seeking and utilizing treatment options. Efforts to reduce the prevalence of smoking during pregnancy might specifically target women with SPD, where the potential for impact is substantial.
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Affiliation(s)
- Renee D Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Keely Cheslack-Postava
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Deborah B Nelson
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA
- Department of Obstetrics and Gynecology, Temple University School of Medicine, Philadelphia, PA
| | - Philip H Smith
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY School of Medicine, New York, NY
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
| | - Teresa Janevic
- Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Nina Bakoyiannis
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Queens, NY
| | - Melanie M Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
- New York State Psychiatric Institute, New York, NY
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
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Fallin A, Miller A, Assef S, Ashford K. Perceptions of Electronic Cigarettes Among Medicaid-Eligible Pregnant and Postpartum Women. J Obstet Gynecol Neonatal Nurs 2016; 45:320-5. [PMID: 27083420 DOI: 10.1016/j.jogn.2016.02.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe perceptions and beliefs about electronic cigarette (e-cigarette) use during pregnancy among pregnant and newly postpartum women. DESIGN An exploratory, qualitative descriptive study. SETTING University-affiliated prenatal clinics. PARTICIPANTS Twelve pregnant or recently postpartum women who reported use of tobacco and electronic cigarettes. METHODS Semistructured focus groups were audio recorded and professionally transcribed. The transcripts were coded to consensus and analyzed with MAXQDA software (version 11) using content analysis. RESULTS Four overarching themes emerged: (a) Attraction to E-Cigarettes as a Harm Reduction Strategy, (b) Uncertainty Regarding the Health Effects of E-Cigarettes; (c) Ambivalence Regarding Novel Product Characteristics; and (d) Behaviors Reflected Dual Use and Often Complete Relapse to Traditional Cigarettes. CONCLUSION Pregnant women are initially attracted to e-cigarettes as a harm reduction strategy, but they often return to traditional cigarettes in the postpartum period. Nurses should counsel pregnant women on the adverse effects of fetal exposure to nicotine. Evidence-based nursing interventions are needed to prevent relapse during the postpartum period.
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Correa JB, Simmons VN, Sutton SK, Meltzer LR, Brandon TH. A content analysis of attributions for resuming smoking or maintaining abstinence in the post-partum period. Matern Child Health J 2016; 19:664-74. [PMID: 24996953 DOI: 10.1007/s10995-014-1556-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A significant proportion of women who self-quit smoking during pregnancy subsequently relapse to smoking post-partum. This study examined free-text responses describing attributions of smoking relapse or maintained abstinence at 1, 8, and 12 months post-partum. This study reports secondary analyses from a randomized clinical trial (N = 504) for preventing post-partum smoking relapse. At each follow-up, one survey item asked the participant to describe why she resumed smoking or what helped her maintain abstinence. A thematic content analysis was conducted on responses from the 472 participants (94.0 % of the original sample) who returned at least 1 survey. Content analyses revealed several themes for participants' reasons for relapse and abstinence. Stress was the most frequently cited reason for smoking relapse across all follow-ups. Health concerns for children and family was the most common reason provided for remaining abstinent. Chi square analyses revealed differences in written responses related to income, age, and depressive symptoms. Overall, these findings suggest that during the post-partum period, stress and familial health concerns are perceived contributors to smoking relapse and abstinence, respectively. These results confirmed key risk and protective factors that have been identified through other assessment modalities (e.g., quantitative surveys and focus groups). They also provide support for targeting these variables in the development, content, and delivery of future post-partum smoking relapse-prevention interventions. The high response rate to these open-ended attribution questions suggests that future studies would benefit from including these and similar items to allow for additional insight into participant perspectives.
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Affiliation(s)
- John B Correa
- Department of Psychology, University of South Florida, 4202 East Fowler Avenue, PCD4118G, Tampa, FL, 33620, USA
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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Smoking and pregnancy--a review on the first major environmental risk factor of the unborn. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:6485-99. [PMID: 24351784 PMCID: PMC3881126 DOI: 10.3390/ijerph10126485] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/12/2013] [Accepted: 11/13/2013] [Indexed: 12/23/2022]
Abstract
Smoking cigarettes throughout pregnancy is one of the single most important avoidable causes of adverse pregnancy outcomes and it represents the first major environmental risk of the unborn. If compared with other risk factors in the perinatal period, exposure to tobacco smoke is considered to be amongst the most harmful and it is associated with high rates of long and short term morbidity and mortality for mother and child. A variety of adverse pregnancy outcomes are linked with cigarette consumption before and during pregnancy. Maternal prenatal cigarette smoke disturbs the equilibrium among the oxidant and antioxidant system, has negative impact on the genetic and cellular level of both mother and fetus and causes a large quantity of diseases in the unborn child. These smoking-induced damages for the unborn offspring manifest themselves at various times in life and for most only a very limited range of causal treatment exists. Education, support and assistance are of high importance to decrease maternal and fetal morbidity and mortality, as there are few other avoidable factors which influence a child's health that profoundly throughout its life. It is imperative that smoking control should be seen as a public health priority.
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Mak KK, Ho SY, Day JR. A Review of Life-Course Familial and Lifestyle Factors of Smoking Initiation and Cessation. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0341-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rattan D, Mamun A, Najman JM, Williams GM, Doi SA. Smoking behaviour in pregnancy and its impact on smoking cessation at various intervals during follow-up over 21 years: a prospective cohort study. BJOG 2012; 120:288-95; discussion 296. [DOI: 10.1111/1471-0528.12027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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