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Massey SH, Pool LR, Estabrook R, Level RA, Shisler S, Stacks AM, Neiderhiser JM, Espy KA, Wakschlag LS, Eiden RD, Allen NB. Within-person decline in pregnancy smoking is observable prior to pregnancy awareness: Evidence across two independent observational cohorts. Addict Biol 2022; 27:e13245. [PMID: 36301213 PMCID: PMC9939010 DOI: 10.1111/adb.13245] [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: 05/11/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
Decreased consumption of nicotine and other drugs during pregnancy appears to be a cross-species phenomenon from which mechanism(s) capable of interrupting addictive processes could be elucidated. Whether pregnancy influences smoking behaviour independent of women's knowledge of the pregnancy, however, has not been considered. Using repeated measures analysis of variance (ANOVA), we estimated within-person change in mean cigarettes/day smoked across the estimated date of conception but prior to individually reported dates of pregnancy recognition using longitudinal smoking data from two independent observational cohorts, the Growing Up Healthy (GUH, n = 271) and Midwest Infant Development Studies (MIDS, n = 145). Participants smoked an average of half a pack/day in the month immediately before conception (M (SD) = 12(8.1) and 9.5(6.7) cigarettes/day in GUH and MIDS, respectively). We observed within-person declines in smoking after conception, both before (MGUH = -0.9; 95% CI -1.6, -0.2; p = 0.01; MMIDS = -1.1; 95% CI -1.9, -0.3; p = 0.01) and after (MGUH = -4.8; 95% CI -5.5, -4.1; p < 0.001; MMIDS = -3.3; 95% CI -4.4, -2.5; p < 0.001) women were aware of having conceived, even when women who had quit and women who were planning to conceive were excluded from analyses. Pregnancy may interrupt smoking-related processes via mechanisms not previously considered. Plausible candidates and directions for future research are discussed.
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Affiliation(s)
- Suena H. Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Deparment of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsay R. Pool
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Deparment of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryne Estabrook
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rachel A. Level
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shannon Shisler
- Research Institute on Addictions, University at Buffalo, Buffalo, New York, USA
| | - Ann M. Stacks
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan, USA
| | - Jenae M. Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly A. Espy
- Department of Neuroscience, Developmental and Regenerative Biology; Department of Psychiatry and Behavioral Science, Long School of Medicine, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Lauren S. Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rina D. Eiden
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Norrina B. Allen
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Massey SH, Estabrook R, Lapping-Carr L, Newmark RL, Decety J, Wisner KL, Wakschlag LS. Are empathic processes mechanisms of pregnancy's protective effect on smoking? Identification of a novel target for preventive intervention. Soc Sci Med 2022; 305:115071. [PMID: 35660692 DOI: 10.1016/j.socscimed.2022.115071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/19/2022] [Accepted: 05/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Spontaneous cessation and reduction in smoking by pregnant women suggest that concern about others, or empathy, could be a malleable target for intervention. We examined various empathy-related processes in relations to reported and biochemically assessed smoking during pregnancy. METHODS Participants were 154 pregnant women (M = 12.4 weeks gestation, SD = 4.6) who were smoking cigarettes immediately prior to pregnancy recognition (85 had quit and 69 were still smoking at enrollment). Empathy-related processes were measured with performance-based paradigms (affect sharing, empathic concern, and theory of mind) and a speech sample (expressed emotion). Smoking was assessed with timeline follow back interviews and urine cotinine assays. Using zero-inflated Poisson regression models, we tested direct and interactive effects of empathy-related processes with respect to biologically verified smoking cessation (zero portion); and mean cigarettes/day smoked after pregnancy recognition among persistent smokers (count portion). RESULTS Affect sharing was inversely related to post-recognition cigarettes/day (B(SE) = -0.17(0.07), 95%C.I. -0.30,-0.04, p = .011) and moderated the relationship between pre-recognition smoking and post-recognition smoking consistent with a buffering effect (B(SE) = -.17(0.05); 95%C.I. - 0.28,-0.06; p = .002). Other empathy related processes showed neither direct nor interactive effects on smoking outcomes. CONCLUSIONS Further research is recommended to clarify the role of empathy in pregnancy smoking.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair Street, 19th Floor, Chicago, IL, 60611, USA.
| | - Ryne Estabrook
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison Street, 1018D, Chicago, IL, 60607, USA
| | - Leiszle Lapping-Carr
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Rebecca L Newmark
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA; University of California San Francisco School of Medicine, 513 Parnassus Ave, Suite S-224, San Francisco, CA, 94143, USA
| | - Jean Decety
- Department of Psychology, Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5848 South University Avenue, Chicago, IL, 60637, USA
| | - Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair Street, 19th Floor, Chicago, IL, 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan, Suite 2100, Chicago, IL, 60611, USA
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Massey SH, Allen NB, Pool LR, Miller ES, Pouppirt NR, Barch DM, Luby J, Perlman SB, Rogers CE, Smyser CD, Wakschlag LS. Impact of prenatal exposure characterization on early risk detection: Methodologic insights for the HEALthy Brain and Child Development (HBCD) study. Neurotoxicol Teratol 2021; 88:107035. [PMID: 34606910 PMCID: PMC8578417 DOI: 10.1016/j.ntt.2021.107035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A major challenge in prenatal drug exposure research concerns the balance of measurement quality with sample sizes necessary to address confounders. To inform the selection of optimal exposure measures for the HEALthy Brain and Child Development (HBCD) Study, we employed integrated analysis to determine how different methods used to characterize prenatal tobacco exposure influence the detection of exposure-related risk, as reflected in normal variations in birth weight. METHODS Participants were N = 2323 mother-infant dyads derived from 7 independent developmental cohorts harmonized on measures of exposure, outcome (birthweight), and covariates. We compared estimates of PTE-related effects on birthweight derived from linear regression models when PTE was categorized dichotomously based on any fetal exposure (30% exposed; 69% not exposed); versus categorically, based on common patterns of maternal smoking during pregnancy (never smoked 69%; quit smoking 16%; smoked intermittently 2%; smoked persistently 13%). We secondarily explored sex differences in PTE-birthweight associations across these categorization methods. RESULTS When PTE was categorized dichotomously, exposure was associated with a - 125-g difference in birthweight (95% C.I. -173.7 - -76.6, p < .0001). When PTE was characterized categorically based on maternal smoking patterns, however, exposure was associated with either no difference in birthweight if mothers quit smoking by the end of the first trimester (B = -30.6, 95% C.I. -88.7-27.4, p = .30); or a - 221.8 g difference in birthweight if mothers did not [95% C.I. (-161.7 to -282.0); p < .001]. Qualitative sex differences were also detected though PTE x sex interactions did not reach statistical significance. Maternal smoking cessation during pregnancy was associated with a 239.3 g increase in birthweight for male infants, and a 114.0 g increase in birthweight for females infants (p = .07). CONCLUSIONS Categorization of PTE based on patterns of maternal smoking rather than the presence or absence of exposure alone revealed striking nuances in estimates of exposure-related risk. The described method that captures both between-individual and within-individual variability in prenatal drug exposure is optimal and recommended for future developmental investigations such as the HBCD Study.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 1000, Chicago, IL 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Avenue, Suite 2100, Chicago, IL 60611, USA; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA.
| | - Norrina B Allen
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lakeshore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Lindsay R Pool
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lakeshore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Emily S Miller
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA; Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Room 05-2175, Chicago, IL 60611, USA.
| | - Nicole R Pouppirt
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA; Department of Pediatrics, Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 45, Chicago, IL 60611, USA.
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, Box 1125, One Brookings Drive, St. Louis, MO 63130, USA.
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 660 S. Euclid Box 8511, St. Louis, MO 63110, USA.
| | - Susan B Perlman
- Department of Child and Adolescent Psychiatry, Washington University School of Medicine in St. Louis, 4444 Forest Park Ave, St. Louis, MO 63110, United States of America.
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine in St. Louis, 660 S. Euclid Box 8511, St. Louis, MO 63110, USA.
| | - Chris D Smyser
- Departments of Neurology, Pediatrics, and Radiology, Washington University School of Medicine in St. Louis, 4525 Scott Avenue, St. Louis, MO 63110, USA.
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Avenue, Suite 2100, Chicago, IL 60611, USA; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 19(th) floor, Chicago, IL 60611, USA.
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Rutherford HJV, Mayes LC. Parenting stress: A novel mechanism of addiction vulnerability. Neurobiol Stress 2019; 11:100172. [PMID: 31193862 PMCID: PMC6543178 DOI: 10.1016/j.ynstr.2019.100172] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/10/2019] [Accepted: 05/15/2019] [Indexed: 02/03/2023] Open
Abstract
Addiction remains a significant public health concern. Despite numerous public health initiatives, many parents continue to use substances during the prenatal and postpartum period. While stress has been implicated in the maintenance of substance use disorders more generally, we propose that parenting stress specifically increases vulnerability to substance use in adults caring for young children. To explore this notion, we first consider the neurobiology of the adult transition to parenthood and the value of adopting a parenting-specific approach to understanding addictive processes. Next, we consider the neurobiology of addiction and parenting before directly addressing parenting stress in the context of addiction. Finally, we describe current interventions with parents that incorporate the management of negative affect to enhance caregiving quality and decrease substance use. Taken together, this article proposes that the unique demands of caring for a developing child may be more stressful above and beyond other forms of stress. As a consequence, intervention approaches that target stress in the parenting role hold promise for decreasing parental substance abuse.
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