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Castro EM, Lotfipour S, Leslie FM. Nicotine on the developing brain. Pharmacol Res 2023; 190:106716. [PMID: 36868366 PMCID: PMC10392865 DOI: 10.1016/j.phrs.2023.106716] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
Developmental periods such as gestation and adolescence have enhanced plasticity leaving the brain vulnerable to harmful effects from nicotine use. Proper brain maturation and circuit organization is critical for normal physiological and behavioral outcomes. Although cigarette smoking has declined in popularity, noncombustible nicotine products are readily used. The misperceived safety of these alternatives lead to widespread use among vulnerable populations such as pregnant women and adolescents. Nicotine exposure during these sensitive developmental windows is detrimental to cardiorespiratory function, learning and memory, executive function, and reward related circuitry. In this review, we will discuss clinical and preclinical evidence of the adverse alterations in the brain and behavior following nicotine exposure. Time-dependent nicotine-induced changes in reward related brain regions and drug reward behaviors will be discussed and highlight unique sensitivities within a developmental period. We will also review long lasting effects of developmental exposure persisting into adulthood, along with permanent epigenetic changes in the genome which can be passed to future generations. Taken together, it is critical to evaluate the consequences of nicotine exposure during these vulnerable developmental windows due to its direct impact on cognition, potential trajectories for other substance use, and implicated mechanisms for the neurobiology of substance use disorders.
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Affiliation(s)
- Emily M Castro
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA, USA
| | - Shahrdad Lotfipour
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA, USA; Department of Emergency Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA; Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Frances M Leslie
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA, USA.
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Smoking cessation Through Optimization of clinical care in Pregnancy: the STOP pragmatic randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:100763. [PMID: 36216314 DOI: 10.1016/j.ajogmf.2022.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Smoking cessation improves pregnancy outcomes, yet there is uncertainty around the efficacy of models of antenatal intervention for smoking cessation in pregnancy. OBJECTIVE This study aimed to test the Smoking cessation Through Optimization of clinical care in Pregnancy (STOP) clinic as an antenatal care pathway for smoking cessation in pregnancy. The STOP intervention is a smoking cessation clinic staffed by a dedicated multidisciplinary team of obstetricians, midwives, and smoking cessation practitioners, who provide motivational and psychological support and intensive clinical monitoring of pregnancy. STUDY DESIGN This was a pragmatic randomized controlled trial of the STOP clinic compared with routine antenatal care at a tertiary urban maternity hospital delivering >8000 infants per year. The primary outcome measured was continuous abstinence from smoking before 28+0 weeks' gestation, sustained throughout the duration of the pregnancy, and validated using biological measures. The secondary outcomes included maternal and fetal morbidity, delivery and neonatal outcomes, smoking outcomes, and qualitative measures. RESULTS A total of 436 women were randomized, with 430 women included in the primary outcome analysis. Women attending the STOP antenatal clinic were more likely to quit smoking compared with those in routine care (odds ratio, 3.62; 95% confidence interval, 1.43-9.17). In addition, women who continued to smoke in the STOP clinic smoked fewer cigarettes daily at the time of delivery compared with controls: 5±4 in the STOP clinic and 7±5 in the control group (odds ratio, 0.28; 95% confidence interval, 0.13-0.59). However, this intervention did not alter postpartum relapse rates (4.3% intervention arm vs 1.5% control arm, not significant) at 4 to 6 months following delivery. The mean birthweight was similar in the intervention and control arms; however, quitters in both groups had infants with significantly higher birthweights compared with those of continued smokers. CONCLUSION The STOP antenatal model of care leads to higher smoking cessation rates among pregnant smokers and lower daily cigarette consumption at time of delivery. Currently, there is no defined or dedicated antenatal pathway for pregnant smokers, despite the high-risk nature of their pregnancies. Our findings suggest that improved smoking cessation rates in pregnancy may be achieved using the holistic approach of the STOP model of care.
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Anai A, Asato K, Tatsuta N, Sakurai K, Ota C, Kuriyama S, Sugawara J, Arima T, Yaegashi N, Nakai K. Factors associated with postpartum smoking relapse at early postpartum period of Japanese women in the Japan Environmental and Children's Study. Environ Health Prev Med 2023; 28:56. [PMID: 37766542 PMCID: PMC10569968 DOI: 10.1265/ehpm.23-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/28/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Postpartum smoking relapse is a serious public health concern. Previous studies have identified several risk factors for postpartum smoking relapse; however, very little is known about the predictors of early postpartum smoking relapse. This study aimed to determine postpartum smoking relapse status and its associated risk factors at 1 month postpartum among Japanese women. METHODS Data were obtained from 93,851 mothers with live births in an ongoing birth cohort study, the Japan Environment and Children's Study. Data on smoking status and confounding variables were collected using self-administered questionnaires and medical record transcripts. Self-administered questionnaires were administered during the first trimester, second/third trimester, and 1 month after delivery. A multiple logistic regression analysis was performed. RESULTS Among the 14,326 mothers who smoked during pregnancy, 10,917 (76.2%) quit smoking during pregnancy. Subsequently, 617 (5.7%) of the mothers who had quit relapsed smoking at 1 month postpartum. Maternal age (≤24, ≥35), maternal education (≤12 years), parity (≥Second), feeding method (Formula milk), partner smoking status during pregnancy (Smoker), number of cigarettes per day before the cessation of smoking (≥11), maternal alcohol consumption at 1-month postpartum (Drinker), postpartum depression (EPDS score ≥9), and spending time at the parents' home after delivery (≥14 days) were associated with smoking relapse. CONCLUSIONS A certain number of mothers relapsed even 1 month postpartum. Besides mother's alcohol and smoking habit before pregnancy, breastfeeding and partner smoking are important factors in early postpartum smoking relapse in Japan.
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Affiliation(s)
- Akane Anai
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
- Institute for Asian and Oceanian Studies, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, Fukuoka 819-0395, Japan
| | - Kaname Asato
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Nozomi Tatsuta
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Kasumi Sakurai
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Chiharu Ota
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Shinichi Kuriyama
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Junichi Sugawara
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Takahiro Arima
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Nobuo Yaegashi
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Kunihiko Nakai
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
- School of Sport and Health Science, Tokai Gakuen University, 21-233 Nishinohora, Ukigai-cho, Miyoshi, Aichi 470-0207, Japan
| | - The Japan Environment and Children’s Study Group
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
- Environmental and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
- Institute for Asian and Oceanian Studies, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, Fukuoka 819-0395, Japan
- School of Sport and Health Science, Tokai Gakuen University, 21-233 Nishinohora, Ukigai-cho, Miyoshi, Aichi 470-0207, Japan
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Knowledge, Attitudes, and Beliefs about Relapse Prevention Research Involving Bupropion among Current and Former Pregnant Individuals Who Smoke. J Smok Cessat 2022; 2022:1925071. [PMID: 36618776 PMCID: PMC9788884 DOI: 10.1155/2022/1925071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/29/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction While many individuals quit smoking during pregnancy, most relapse within one year postpartum. Research into methods to decrease smoking relapse postpartum has been hampered by difficulties with recruitment. Method We conducted individual interviews with pregnant women (N = 22) who were interested in quitting smoking while pregnant about their attitudes regarding smoking and quitting during pregnancy, clinical trial participation, and smoking cessation medication use. Results Participants were aware of the risks of smoking while pregnant. Many wanted to quit smoking before delivery. Few used empirically supported treatments to quit. While research was viewed positively, interest in taking on new commitments postpartum and taking a medication to prevent relapse was low. Medication concerns were evident among most participants, especially among those planning to breastfeed. Further, several women noted medication was unnecessary, as they did not believe they would relapse postpartum. Financial incentives, childcare, and fewer and/or remote visits were identified as facilitators to participating in research. However, these factors did not outweigh women's concerns about medication use and time commitments. Conclusions Women are aware that quitting smoking during pregnancy and remaining smoke-free postpartum are important. However, beliefs that personal relapse risk is low and that medications are dangerous reduced enthusiasm for taking medication for postpartum relapse prevention. Future medication trials should educate women about the high likelihood of relapse, prepare to answer detailed questions about risks of cessation medications, and connect with participants' clinicians. For new mothers, studies conducted remotely with few scheduled appointments would reduce barriers to participation.
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Pereira Júnior AA, de Amorim GES, Garcia RCT, Ribeiro JM, Silva AO, Almeida CADF, Ceron CS, Ruginsk SG, Antunes-Rodrigues J, Elias LLK, Dias MVS, Marcourakis T, Torres LH. Nicotine exposure through breastfeeding affects BDNF and synaptic proteins levels in the brain of stressed adult female mice. Int J Dev Neurosci 2022; 82:759-771. [PMID: 36018565 DOI: 10.1002/jdn.10227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
Nicotine has been used during pregnancy and lactation as a tobacco harm reduction strategy. However, it is unclear whether nicotine exposure during a critical development period negatively impacts stress responses in adulthood. This study investigated how nicotine, administered via breastfeeding, affects the brain-derived neurotrophic factor (BDNF), synaptic proteins levels, and anxiety-like behavior in adult female mice subjected to stress. Female Swiss mice were exposed to saline or nicotine (8 mg/kg/day) through breastfeeding between their fourth and 17th postnatal days (P) via implanted osmotic mini pumps. The unpredictable chronic mild stress (UCMS) protocol was performed during their adulthood (P65) for 10 consecutive days, followed by the elevated plus maze (EPM) test one day after the protocol. Animals were euthanized and their blood, collected for plasma corticosterone measurements and their brain structures, dissected for BDNF and synaptic proteins analyses. We found no significant differences in corticosterone levels between groups (Saline/Non-stress, Nicotine/Non-stress, Saline/Stress, and Nicotine/Stress). The UCMS protocol hindered weight gain. Mice exposed to nicotine through breastfeeding with or without the UCMS protocol in adulthood showed higher grooming and head dipping frequency; decreased BDNF levels in cerebellum and striatum; increased postsynaptic density protein 95 (PSD-95), synapsin I, and synaptophysin levels in cerebellum; and decreased PSD-95 and synapsin I levels in brainstem. Our results indicate that nicotine exposure through breastfeeding leads to long-lasting behavioral effects and synaptic protein changes, most of which were independent of the UCMS protocol, even after a long nicotine-free period, highlighting the importance of further studies on nicotine exposure during development.
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Affiliation(s)
- Antonio Alves Pereira Júnior
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | | | - Raphael Caio Tamborelli Garcia
- Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo Diadema, São Paulo, Brazil
| | - Jéssyca Milene Ribeiro
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Alessandra Oliveira Silva
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | | | - Carla Speroni Ceron
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Silvia Graciela Ruginsk
- Department of Physiological Sciences, Biomedical Sciences Institute, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - José Antunes-Rodrigues
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucila Leico Kagohara Elias
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Tania Marcourakis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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Zhang K, Siziba LP, Suo NJ, Rothenbacher D, Genuneit J. Breastfeeding duration is positively associated with decreased smoking relapse in the postpartum period. Midwifery 2022; 108:103289. [DOI: 10.1016/j.midw.2022.103289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/07/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
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Orton S, Taylor L, Laing L, Lewis S, Ussher M, Coleman T, Cooper S. Are E-cigarettes associated with postpartum return to smoking? Secondary analyses of a UK pregnancy longitudinal cohort. BMJ Open 2022; 12:e061028. [PMID: 35414565 PMCID: PMC9006833 DOI: 10.1136/bmjopen-2022-061028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Postpartum return to smoking (PPRS) is an important public health problem. E-cigarette (EC) use has increased in recent years, and in a contemporary UK pregnancy cohort, we investigated factors, including ECs use, associated with PPRS. DESIGN Secondary analyses of a longitudinal cohort survey with questionnaires at baseline (8-26 weeks' gestation), late pregnancy (34-36 weeks) and 3 months after delivery. SETTING 17 hospitals in England and Scotland in 2017. PARTICIPANTS The cohort recruited 750 women who were current or recent ex-smokers and/or EC users. A subgroup of women reported being abstinent from smoking in late pregnancy (n=162, 21.6%), and of these 137 (84.6%) completed the postpartum questionnaire and were included in analyses. OUTCOME MEASURES Demographics, smoking behaviours and beliefs, views and experience of ECs and infant feeding. RESULTS 35.8% (95% CI 28% to 44%) of women reported PPRS. EC use in pregnancy (adjusted OR 0.34, 95% CI 0.13 to 0.85) and breast feeding (adjusted OR 0.06, 95% CI 0.02 to 0.24) were inversely associated with PPRS, while household member smoking at 3 months post partum was positively associated with PPRS (adjusted OR 11.1, 95% CI 2.47 to 50.2). CONCLUSION EC use in pregnancy could influence PPRS. Further research is needed to confirm this and investigate whether ECs could be used to prevent PPRS.
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Affiliation(s)
- Sophie Orton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Lauren Taylor
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Libby Laing
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Division of Population Health Sciences and Education, St George's University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- School of Medicine, University of Nottingham, Nottingham, UK
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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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9
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Nordhagen LS, Kreyberg I, Bains KES, Carlsen K, Glavin K, Skjerven HO, Småstuen MC, Hilde K, Nordlund B, Vettukattil R, Hedlin G, Granum B, Jonassen CM, Gudmundsdóttir HK, Haugen G, Rehbinder EM, Söderhäll C, Staff AC, Lødrup Carlsen KC, Asarnoj A, Lødrup Carlsen OC, Wik Despriée Å, Dyrseth V, Endre KA, Granlund PA, Holmstrøm H, Håland G, Mägi CO, Nygaard UC, Rudi K, Saunders CM, Sjøborg KD, Skrindo I, Tedner SG, Værnesbranden MR, Wiik J. Maternal use of nicotine products and breastfeeding 3 months postpartum. Acta Paediatr 2020; 109:2594-2603. [PMID: 32274823 DOI: 10.1111/apa.15299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 01/19/2023]
Abstract
AIM We aimed to determine the prevalence of and factors associated with maternal use of nicotine products in relation to breastfeeding. METHODS Nicotine use 3 months postpartum was determined in the Scandinavian PreventADALL mother-child birth cohort study recruiting 1837 women from 2014 to 2016. Electronic questionnaires at 18 weeks pregnancy and 3 months postpartum provided information on snus use, smoking or other nicotine use, infant feeding and socio-economic factors. The risk of nicotine use in relation to breastfeeding was analysed with logistic regression. RESULTS Overall, 5.6% of women used snus (2.9%), smoked (2.7%) or both (n = 2) 3 months postpartum, while one used other nicotine products. Among the 1717 breastfeeding women, 95.1% reported no nicotine use, while 2.4% used snus, 2.5% smoked and one dual user. Compared to 3.7% nicotine use in exclusively breastfeeding women (n = 1242), the risk of nicotine use increased by partly (OR 2.26, 95% CI 1.45-3.52) and no breastfeeding (OR 4.58, 95% CI 2.57-8.21). Nicotine use before (14.5% snus, 16.4% smoking) or in pregnancy (0.2% snus, 0.4% smoking) significantly increased the risk of using nicotine during breastfeeding. CONCLUSION Few breastfeeding women used snus or smoked 3 months postpartum, with increased risk by nicotine use before or during pregnancy.
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Affiliation(s)
- Live S. Nordhagen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- VID Specialized University Oslo Norway
| | - Ina Kreyberg
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Karen Eline S. Bains
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Kai‐Håkon Carlsen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | | | - Håvard O. Skjerven
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | | | - Katarina Hilde
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Obstetrics and Gynaecology Oslo University Hospital Oslo Norway
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Riyas Vettukattil
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Berit Granum
- Department of Environmental Health Norwegian Institute of Public Health Oslo Norway
| | - Christine M. Jonassen
- Faculty of Chemistry, Biotechnology and Food Science Norwegian University of Life Sciences Ås Norway
- Genetic Unit Centre for Laboratory Medicine Østfold Hospital Trust Kalnes Norway
| | - Hrefna K. Gudmundsdóttir
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
| | - Guttorm Haugen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Obstetrics and Gynaecology Oslo University Hospital Oslo Norway
| | - Eva Maria Rehbinder
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Department of Dermatology Oslo University Hospital Oslo Norway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital Karolinska University Hospital Stockholm Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Anne Cathrine Staff
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Obstetrics and Gynaecology Oslo University Hospital Oslo Norway
| | - Karin C. Lødrup Carlsen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Division of Paediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
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Factors Associated with Smoking Relapse in the Early Postpartum Period: A Prospective Longitudinal Study in Spain. Matern Child Health J 2020; 25:998-1006. [DOI: 10.1007/s10995-020-03019-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
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Ueda K, Kitano N, Suzuki K. Description of Maternal Smoking Status Before and After Pregnancy: A Longitudinal, Community-Based Cohort Study. J Epidemiol 2020; 30:295-300. [PMID: 31474674 PMCID: PMC7280056 DOI: 10.2188/jea.je20180187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Maternal smoking during pregnancy is a major risk for adverse perinatal outcomes, as well as children’s health status. Thus, it is important to describe maternal smoking status during pregnancy and child-rearing to devise better intervention strategies. However, there have been no longitudinal studies to describe the status. Thus, in this study, we aimed to describe maternal smoking status during pregnancy and child-rearing based on population-based maternal and child health information. Moreover, we explored the factors associated with maternal smoking relapse after delivery. Methods We performed a survey of 1,220 mothers in a Japanese rural area who responded to a questionnaire upon registration of their pregnancies. When their children received health checkups at 4, 18, and 36 months of age, maternal smoking status was also surveyed. We then performed multiple logistic regression analysis to explore factors associated with maternal smoking relapse after delivery. Results Ultimately, the total number of mothers with data available for longitudinal analysis was 727 (59.6%). At the time of pregnancy registration, there were 74 current smokers (10.2%) and 176 former smokers (24.2%). Among them, 59 (33.5%) relapsed after delivery. Under 28 years of maternal age at pregnancy registration (OR 2.6; 95% CI, 1.2–5.4) was associated with maternal smoking relapse after delivery. Conclusions Longitudinal analyses showed that about 60% of mothers who smoked before and after delivery failed smoking cessation. In addition, younger mothers were significantly likely to relapse smoking after delivery.
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Affiliation(s)
| | - Naomi Kitano
- Research Center for Community Medicine and Department of Public Health, School of Medicine, Wakayama Medical University
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine
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Nwosu C, Angus K, Cheeseman H, Semple S. Reducing Secondhand Smoke Exposure Among Nonsmoking Pregnant Women: A Systematic Review. Nicotine Tob Res 2020; 22:2127-2133. [DOI: 10.1093/ntr/ntaa089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
Abstract
Introduction
Exposure to secondhand smoke (SHS) in pregnancy leads to an increased risk of stillbirths, congenital malformations, and low birth weight. There is a lack of evidence about how best to achieve reductions in SHS exposure among nonsmoking pregnant women. This work systematically reviews individual or household interventions to reduce pregnant women’s exposure to SHS.
Methods
MEDLINE, EMBASE, and CINAHL databases were searched from their dates of inception to April 17, 2019. Studies were included if: participants were nonsmoking pregnant women; involved an intervention to reduce SHS exposure or encourage partner quitting; and measured SHS exposure of pregnant women and/or recorded quit rates among partners. The UK National Institute for Health & Care Excellence (NICE) Quality Appraisal checklist was used to determine internal and external validity.
Results
Nine studies met the inclusion criteria. Educational interventions were primarily targeted at the pregnant woman to change her or others’ behavior, with only two studies involving the partner who smoked. Intervention delivery was mixed, spanning brief discussions through to more involving sessions with role play. The effective interventions involved multiple follow-ups. There was no standardized method of assessing exposure to SHS. Many of the included studies had moderate to high risk of bias.
Conclusion
There is mixed evidence for interventions aimed at reducing pregnant women’s exposure to SHS, though multi-component interventions seem to be more effective. The effectiveness of family-centered approaches involving creating smoke-free homes alongside partner smoking cessation, perhaps involving pharmacological support and/or financial incentives, should be explored.
Implications
• Measures to protect nonsmoking pregnant women from SHS tend to place the responsibility for “avoidance” on the woman.
• There is little work that seeks to involve the smoking partner or other smokers in protecting pregnant women from SHS.
• Interventions to create smoke-free homes and/or smoking partner cessation need to be developed: pharmacological and financial support should be explored.
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Affiliation(s)
| | - Kathryn Angus
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | - Sean Semple
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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13
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Drehmer JE, Ossip DJ, Nabi-Burza E, Hipple Walters B, Gorzkowski JA, Winickoff JP. Pediatric Office Delivery of Smoking Cessation Assistance for Breast-Feeding Mothers. Nicotine Tob Res 2020; 22:346-353. [PMID: 30521040 DOI: 10.1093/ntr/nty247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 11/13/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION National and international organizations have done an excellent job of advocating and promoting breast feeding for all mothers. This study assessed to what extent an intervention increased delivery of cessation assistance to breast-feeding mothers who smoke. METHODS Data were collected between April and October 2015 in five US states as part of a cluster randomized controlled trial in 10 pediatric practices. Practices were randomized to the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention or usual care control arms. Mothers were asked about their smoking status and breast-feeding history during a screening interview upon exiting the practice and eligible mothers who agreed to participate in an enrollment interview were asked if they received smoking cessation assistance during their child's visit. Mothers with a child 1 year old and younger were included in the analyses. RESULTS Current breast feeding was associated with a reduced likelihood of current smoking (adjusted odds ratio [aOR] = 0.38, 95% confidence interval [95% CI] = 0.25 to 0.57) and a greater likelihood of quitting smoking (aOR = 2.33, 95% CI = 1.29 to 4.21) after controlling for known confounders. Mothers who concurrently smoked and breast-fed were more likely to be asked about smoking (66.7% vs. 28.6%, p = .01), advised to quit (61.1% vs. 21.4%, p < .01), prescribed nicotine replacement therapy (50.0% vs. 0%, p < .001), and enrolled into the quitline (27.8% vs. 0%, p < .01) at CEASE practices compared to control practices. CONCLUSION Breast-feeding mothers were less likely to be current smokers and more likely to have recently quit smoking. Among mothers who continue to smoke and breast feed, the CEASE intervention enhances delivery of smoking cessation assistance. IMPLICATIONS Breast feeding and eliminating infants' exposure to tobacco smoke are important protective factors for serious pediatric health risks including sudden infant death. This study shows that breast feeding was positively associated with desirable tobacco control outcomes, specifically that breast feeding was associated with a lower likelihood of smoking among ever smokers and a greater likelihood of recently quitting smoking. This is also the first study to look specifically at delivery of smoking cessation assistance to breast-feeding mothers seen at pediatric offices and demonstrates the effectiveness of delivering evidence-based smoking cessation assistance to them in this context. TRIAL REGISTRATION www.ClinicalTrials.gov (identifier NCT01882348).
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Affiliation(s)
- Jeremy E Drehmer
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Emara Nabi-Burza
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Bethany Hipple Walters
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Julie A Gorzkowski
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA.,Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL
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14
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Alaniz K, Christiansen B, Sullivan T, Khalil L, Fiore MC. Addressing Postpartum Smoking Relapse Among Low-Income Women: A Randomized Control Trial. J Patient Cent Res Rev 2019; 6:233-242. [PMID: 31768402 PMCID: PMC6827840 DOI: 10.17294/2330-0698.1702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Smoking during pregnancy can have dire consequences for both the baby and mother. Low-income pregnant women smoke at particularly high rates. Among women who quit during pregnancy, postpartum relapse is high. This randomized control trial tested the effect of adding postpartum assistance to an existing smoking cessation program (First Breath) designed for low-income women. METHODS Of 185 study participants, 94 women were randomly assigned to the standard First Breath program (control) and 91 to an enhanced program. First Breath consisted of evidence-based smoking cessation counseling provided at every prenatal visit. The enhanced program included all First Breath services plus 4 in-home counseling visits (3 postpartum), 3 postpartum counseling calls, support to others in the home, and incentives (gift cards) totaling $100. The primary outcome was biochemically verified abstinence at 6 months postpartum. RESULTS Among the 98 women who completed the study, the abstinence rate among the intervention participants (n=41) was significantly greater than among the control participants (n=57) (36.6% vs 12.3%, respectively; P<0.01). Analyzed on an intent-to-treat basis, with those lost to follow-up assumed to be smoking, the abstinence rate among intervention subjects (n=91) was 16.5% vs 7.4% among control participants (n=94); P=0.07. CONCLUSIONS Extending smoking cessation interventions into the postpartum period may help address postpartum relapse.
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Affiliation(s)
| | - Bruce Christiansen
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Michael C. Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
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15
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Lin CL, Lee TSH, Hsu CC, Chen CY, Chao E, Shih SF, Hu HY. Factors associated with post-partum smoking relapse in Taiwan: A trial of Smoker's helpline. Taiwan J Obstet Gynecol 2019; 58:667-672. [PMID: 31542090 DOI: 10.1016/j.tjog.2019.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Many women quit smoking during pregnancy resume in postpartum period and difficult to prevent. No studies had focused on their psychosocial response in Taiwan. We analyzed data from a trial of Taiwan Smoker's Helpline (TSH) to determine factors associated with smoking relapse after delivery. MATERIALS AND METHODS A prospective cohort was conducted at Taipei City Hospital during Sep. 2014 and Nov. 2015 period. We collected data by self-developed questionnaire combining theory of planned behavior (TPB), Fagerstrom test for nicotine dependence (FTND) and Edinburgh Postnatal Depression Scale (EPDS) from 68 women immediately after delivery, 2 months later and followed up until 6 months. Multivariable logistic models for relapse of smoking at the end of 3rd month and 6th month were created. RESULTS At 6th month, 42.6% participants relapsed with odds lower among first parity (OR = 0.04, 95% CI = <0.01-0.54, p = 0.015), having quitting experience in past (OR = 0.09, 95% CI = 0.01-0.84, p = 0.019) and higher perceived behavior control (PBC) (OR = 0.99, 95% CI = 0.98-1.00, p = 0.035), but greater for those with longer smoking duration in past (OR = 1.29, 95% CI = 1.04-1.58, p = 0.018). CONCLUSION Protective and precipitating factors to post-partum's smoking relapse were identified in our study.
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Affiliation(s)
- Chen-Li Lin
- Department of Obstetrics and Gynecology, Taipei City Hospital, Taipei, Taiwan.
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
| | - Chih-Cheng Hsu
- Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Cheng-Yu Chen
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - En Chao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan; Songshan Branch, Tri-Service General Hospital, Taipei, Taiwan
| | - Shu-Fang Shih
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; Institute of Public Health & Department of Public Health, National Yang Ming University, Taipei, Taiwan
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16
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McDonnell BP, Dicker P, Keogan S, Clancy L, Regan C. Smoking cessation Through Optimisation of clinical care in Pregnancy: the STOP randomised controlled trial. Trials 2019; 20:550. [PMID: 31481110 PMCID: PMC6724369 DOI: 10.1186/s13063-019-3653-4] [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: 05/09/2019] [Accepted: 08/13/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cigarette smoking negatively impacts on maternal and fetal health. Smoking cessation is one of the few interventions capable of improving pregnancy outcomes. Despite the risks, the most effective antenatal model of care for smokers is still unclear, and specific recommendations for screening for fetal growth restriction are absent. METHODS This is a pragmatic randomised controlled trial of a dedicated smoking cessation clinic versus routine antenatal care as an intervention to reduce cigarette smoking behaviour. Smoking mothers randomised to the Smoking cessation Through Optimisation of clinical care in Pregnancy (STOP) clinic will have all antenatal care provided by a team comprising an obstetrician, a midwife, and a smoking cessation practitioner. This intervention includes ultrasound screening for fetal growth restriction. The control arm comprises two groups: one receiving standard care with ultrasound screening for fetal growth restriction, and one receiving standard care with ultrasound screening for growth restriction only if clinically indicated by their healthcare provider. Four hundred and fifty women will be recruited and randomised to either intervention or control arms stratifying for age, parity, and history of fetal growth restriction. RESULTS The primary outcome is self-reported, continuous abstinence from smoking between the quit date and end of pregnancy, validated by exhaled carbon monoxide or urinary cotinine. The quit date is targeted as being at or before 16 weeks' gestation and no further than 28 weeks' gestation. The secondary outcomes are a set of variables including maternal and fetal morbidity and mortality, neonatal complications and delivery outcomes, smoking and psychological outcomes, and qualitative measures. CONCLUSIONS Despite much research into cigarette smoking in pregnancy, the optimal model of care for these women is still unknown. This study has the potential to improve the model of antenatal care provided to pregnant women who smoke and to improve outcomes for both mother and infant. TRIAL REGISTRATION ISRCTN11214785 . Registered on 8 February 2018.
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Affiliation(s)
- Brendan P McDonnell
- Coombe Women & Infants University Hospital, Cork Street, Dublin 8, Ireland. .,Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Patrick Dicker
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
| | - Sheila Keogan
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Luke Clancy
- TobaccoFree Research Institute, Focas Research Institute, DIT Kevin Street, Camden Row, Dublin 2, Ireland
| | - Carmen Regan
- Coombe Women & Infants University Hospital, Cork Street, Dublin 8, Ireland.,Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland
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17
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Johnston EJ, Campbell K, Coleman T, Lewis S, Orton S, Cooper S. Safety of Electronic Cigarette Use During Breastfeeding: Qualitative Study Using Online Forum Discussions. J Med Internet Res 2019; 21:e11506. [PMID: 31407672 PMCID: PMC6709563 DOI: 10.2196/11506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/15/2019] [Accepted: 03/05/2019] [Indexed: 01/19/2023] Open
Abstract
Background Electronic cigarettes (e-cigs) are an increasingly popular alternative to smoking, helping to prevent relapse in those trying to quit and with the potential to reduce harm as they are likely to be safer than standard cigarettes. Many women return to smoking in the postpartum period having stopped during pregnancy, and while this can affect their decisions about breastfeeding, little is known about women’s opinions on using e-cigs during this period. Objective The aim of this study is to explore online forum users’ current attitudes, motivations, and barriers to postpartum e-cig use, particularly as a breastfeeding mother. Methods Data were collected via publicly accessible (identified by Google search) online forum discussions, and a priori codes identified. All transcripts were entered into NVivo for analysis, with a template approach to thematic analysis being used to code all transcripts from which themes were derived. Results Four themes were identified: use, perceived risk, social support and evidence, with a number of subthemes identified within these. Women were using e-cigs to prevent postpartum return to smoking, but opinions on their safety were conflicting. They were concerned about possible transfer of harmful products from e-cigs via breastmilk and secondhand exposure, so they were actively seeking and sharing information on e-cigs from a variety of sources. Although some women were supportive of e-cig use, others provided harsh judgement for mothers who used them. Conclusions E-cigs have the potential to reduce the number of women who return to smoking in the postpartum period and potentially improve breastfeeding rates, if breastfeeding mothers have access to relevant and reliable information. Health care providers should consider discussing e-cigs with mothers at risk of returning to smoking in the postpartum period.
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Affiliation(s)
- Emily Jade Johnston
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Katarzyna Campbell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Tim Coleman
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Lewis
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sophie Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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18
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Ioakeimidis N, Vlachopoulos C, Katsi V, Tousoulis D. Smoking cessation strategies in pregnancy: Current concepts and controversies. Hellenic J Cardiol 2018; 60:11-15. [PMID: 30296484 DOI: 10.1016/j.hjc.2018.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/08/2018] [Accepted: 09/12/2018] [Indexed: 01/09/2023] Open
Abstract
Smoking during pregnancy is a risk factor associated with adverse pregnancy outcomes. Despite the fact that these outcomes are well known, a considerable proportion of pregnant women continue to smoke during this critical period. This paper evaluates critically smoking cessation interventions targeting pregnant women. We describe the findings of key published studies, review papers and expert statements to report the efficacy and safety of strategies for smoking cessation in pregnancy, including counselling and pharmacotherapy. Counselling appears to improve quit rates but mainly when used in combination with pharmacological therapy. Pharmacotherapy is recommended for women who are heavy smokers and are unable to quit smoking on their own. Nicotine replacement therapy is a reasonable first-line drug option. It is recommended that women who are pregnant, or planning to become pregnant, should be informed of potential risks for the foetus before considering smoking cessation therapy with bupropion or varenicline. Pregnant women view electronic nicotine delivery systems as being safer than combustible cigarettes, and this indeed may be the case; however, further evidence is required to assess their effectiveness as a smoking cessation aid and their safety for the mother and the child. Postpartum relapse is a significant problem, with approximately one out of two quitters relapsing in the first 2 months after delivery. These women should be considered 'at risk' and provided with ongoing support.
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Affiliation(s)
- Nikolaos Ioakeimidis
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian Univeristy of Athens, Hippokration Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian Univeristy of Athens, Hippokration Hospital, Athens, Greece.
| | - Vasiliki Katsi
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian Univeristy of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- Hypertension and Cardiometabolic Syndrome Unit, 1st Department of Cardiology, Medical School, National and Kapodistrian Univeristy of Athens, Hippokration Hospital, Athens, Greece
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19
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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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20
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Schilling C, Hedges MR, Carr PA, Morton S. Transitions in Smoking Across a Pregnancy: New Information from the Growing Up in New Zealand Longitudinal Study. Matern Child Health J 2018; 22:660-669. [DOI: 10.1007/s10995-018-2434-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kia F, Tosun N, Carlson S, Allen S. Examining characteristics associated with quitting smoking during pregnancy and relapse postpartum. Addict Behav 2018; 78:114-119. [PMID: 29149636 PMCID: PMC5783747 DOI: 10.1016/j.addbeh.2017.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/29/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Smoking during pregnancy is a significant public health concern that can cause adverse health outcomes for both the mother and fetus. Studies have shown only 40% of women quit smoking during pregnancy, with more than half relapsing within 6months, and up to 90% relapsing within one year. This study investigates differences in demographics and smoking-related symptomatology between pregnant smokers and pregnant quitters, as well as factors associated with postpartum relapse. METHODS Data on pregnant smokers and pregnant quitters were obtained from two separate parent studies. Data on smoking demographics and smoking-related symptomatology were collected at screening visits. RESULTS Compared to pregnant smokers, pregnant quitters had more favorable smoking characteristics (e.g., smoked fewer cigarettes per day, reported higher motivation for abstinence and less dependency). They also had more favorable relationship characteristics (e.g., were more likely to be married, less likely to have a significant other who smokes) and had less reproductive liability (e.g., fewer pregnancies, fewer children). In terms of symptomatology, pregnant quitters reported more positive affect, negative affect, physical symptoms and withdrawal but less craving. Predictors of postpartum relapse included increased maternal age, having a significant other who smokes and an increased likelihood of returning to smoking after pregnancy (self-reported prior to delivery). CONCLUSIONS Several demographics and smoking-related symptomatology were significantly different between pregnant quitters and pregnant smokers. In addition, multiple factors predicting postpartum relapse were identified. This information can inform personalized interventions for high risk pregnant smokers and pregnant quitters at risk for postpartum relapse.
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Affiliation(s)
- Farnaaz Kia
- Department of Family Medicine & Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States.
| | - Nicole Tosun
- Department of Family Medicine & Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States.
| | - Samantha Carlson
- Department of Family Medicine & Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414, United States.
| | - Sharon Allen
- Department of Family Medicine & Community Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, United States.
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22
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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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23
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Allen SS, Allen AM, Lunos S, Tosun N. Progesterone and Postpartum Smoking Relapse: A Pilot Double-Blind Placebo-Controlled Randomized Trial. Nicotine Tob Res 2016; 18:2145-2153. [PMID: 27613934 PMCID: PMC5055745 DOI: 10.1093/ntr/ntw156] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/05/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Pregnancy is a strong motivator to quit smoking, yet postpartum relapse rates are high. Growing evidence suggests a role of sex hormones in drug abuse behavior and given the precipitous drop in sex hormones at delivery, they may play a role in postpartum relapse. This pilot study evaluates the feasibility and potential role of exogenous progesterone in postpartum smoking relapse. METHODS This 12-week double-blind placebo-controlled randomized pilot trial randomized 46 abstinent postpartum women to active progesterone (PRO; 200mg twice a day) versus placebo (PBO) for 4 weeks. Participants were followed for relapse for 12 weeks. Main study outcomes include abstinence (point prevalence), feasibility (compliance per number of clinic visits attended, pill counts and Electronic Data Capture [EDC] completed) and self-reported acceptability. Safety was also measured by depressive symptom scores, adverse events, and breastfeeding. RESULTS Overall retention rate was 87% at week 12. At week 4, abstinence rates were 75% in the PRO group and 68.2% in the PBO group (p = .75). Medication adherence was 68% and clinic visit attendance was 80%, with no differences by randomization. Depressive symptom scores, adverse events, and breastfeeding did not vary by randomization. CONCLUSIONS Although the study was not powered to evaluate abstinence rates, we did observe a higher prevalence of abstinence at week 4 in the PRO group. Further, exogenous progesterone was well tolerated and did not adversely affect depressive symptoms or breastfeeding. Thus, the results of this pilot study indicate further investigation into progesterone as a postpartum relapse prevention strategy is warranted. IMPLICATIONS This innovative pilot trial determined the feasibility of delivering exogenous progesterone as a potential prevention of postpartum smoking relapse. We observed high retention and moderate adherence rates, as well as high acceptability among participants. Further, though not statistically significant, more women in the treatment group remained abstinent from smoking during follow-up. This project adds to the growing body of literature on the role of sex hormones in smoking relapse and also provides support for a fully powered clinical trial.
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Affiliation(s)
- Sharon S Allen
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN;
| | - Alicia M Allen
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN
| | - Scott Lunos
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Nicole Tosun
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN
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"I Was a Full Time Proper Smoker": A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum. PLoS One 2016; 11:e0157525. [PMID: 27308829 PMCID: PMC4911111 DOI: 10.1371/journal.pone.0157525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 06/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background Many women stop smoking during pregnancy but relapse shortly afterwards, potentially putting their infants at risk of secondhand smoke (SHS) exposure. Women who were able to stop during pregnancy may be a motivated group, receptive to making behaviour changes postpartum to protect their infant from SHS exposure. Understanding more about their experiences of relapse, and if this influences home smoking behaviours and children’s exposure to SHS in the home may help to inform intervention development to prevent infant SHS exposure. Methods Guided by interpretative phenomenological methodology we conducted and analysed nine semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum. Findings Central to mothers’ accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a ‘responsible mother’. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers appeared to reposition themselves as ‘social’ or ‘occasional’ smokers rather than ‘regular’ smokers. Conclusions Findings suggest that interventions to prevent/reduce infants' home SHS exposure should build on mothers' intentions to be responsible parents. As mothers who relapse principally view themselves as ‘social’ or ‘occasional’ smokers, interventions that are highlighted as relevant for women with these types of smoking patterns may be more likely to be responded to, and, ultimately, be effective.
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25
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Fitzpatrick KE, Gray R, Quigley MA. Women's Longitudinal Patterns of Smoking during the Pre-Conception, Pregnancy and Postnatal Period: Evidence from the UK Infant Feeding Survey. PLoS One 2016; 11:e0153447. [PMID: 27111661 PMCID: PMC4844127 DOI: 10.1371/journal.pone.0153447] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An understanding of women's longitudinal patterns of smoking during the pre-conception, pregnancy and postnatal period and the factors associated with these patterns could help better inform smoking cessation services and interventions. METHODS Latent class analysis (LCA) was used to empirically identify women's smoking patterns in a sample of 10,768 mothers from the 2010 UK Infant Feeding Survey. Multinomial logistic regression was used to identify characteristics associated with these patterns. RESULTS LCA identified five distinct smoking patterns during the pre-conception, pregnancy and postnatal period: "non-smokers" (74.1% of women); "pregnancy-inspired quitters" (10.2%); "persistent smokers" (10.1%); "temporary quitters" (4.4%); and postnatal quitters (1.1%). Smoking patterns varied markedly according to socio-demographic variables and parity. After adjusting for these variables, mothers who lived during pregnancy with a partner who smoked were more likely to be temporary quitters (aOR 2.64, 95% CI 1.74-3.99) or persistent smokers (aOR 3.32, 95% CI 2.34-4.72) than pregnancy-inspired quitters. Mothers who lived during pregnancy with someone else other than a partner who smoked were more likely to be persistent smokers (aOR 2.34, 95% CI 1.38-3.97) or postnatal quitters (aOR 2.97, 95% CI 1.07-8.24) than pregnancy-inspired quitters. Mothers given information on how their partner could stop smoking if they lived during pregnancy with a smoking partner were less likely to be persistent smokers (aOR 0.42, 95% CI 0.27-0.65) than pregnancy-inspired quitters. CONCLUSION Health professionals should ask about smoking at every opportunity, and refer women who self-report as current smokers to an evidence based smoking cessation service.
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Affiliation(s)
- Kate E. Fitzpatrick
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ron Gray
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Satoh A, Kishi C, Tomita M, Saitoh M, Hirakawa M, Kumasaka M, Sasaki J, Lee S, Sasaki H. Resumption of Smoking by Women after Childbirth: Influence of Spousal Smoking. Health (London) 2016. [DOI: 10.4236/health.2016.89086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee M, Miller SM, Wen KY, Hui SKA, Roussi P, Hernandez E. Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women. J Behav Med 2015; 38:932-43. [PMID: 26335312 DOI: 10.1007/s10865-015-9669-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
This study evaluated a theory-guided cognitive-behavioral counseling (CBC) intervention for smoking cessation during pregnancy and postpartum. It also explored the mediating role of cognitive-affective variables on the impact of CBC. Underserved inner city pregnant women (N = 277) were randomized to the CBC or a best practice (BP) condition, each of which consisted of two prenatal and two postpartum sessions. Assessments were obtained at baseline, late pregnancy, and 1- and 5-months postpartum. An intent-to-treat analysis found no differences between the two groups in 7-day point-prevalence abstinence. However, a respondents-only analysis revealed a significantly higher cessation rate in the CBC (37.3 %) versus the BP (19.0 %) condition at 5-months postpartum follow-up. This effect was mediated by higher quitting self-efficacy and lower cons of quitting. CBC, based on the Cognitive-Social Health Information Processing model, has the potential to increase postpartum smoking abstinence by assessing and addressing cognitive-affective barriers among women who adhere to the intervention.
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Affiliation(s)
- Minsun Lee
- Department of Psychosocial and Behavioral Medicine Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Suzanne M Miller
- Department of Psychosocial and Behavioral Medicine Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - Kuang-Yi Wen
- Department of Psychosocial and Behavioral Medicine Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Sui-kuen Azor Hui
- Department of Psychosocial and Behavioral Medicine Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Pagona Roussi
- Department of Psychology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Enrique Hernandez
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
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Smoking cessation during pregnancy and relapse after childbirth in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:32-39. [PMID: 25764034 DOI: 10.1016/s1701-2163(15)30360-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This analysis was undertaken to determine the rates and determinants of smoking cessation during pregnancy and smoking relapse after childbirth in Canada. METHODS We used data from the Maternity Experiences Survey, a cross-sectional study of mothers who gave birth to a singleton baby in Canada in 2006. A total of 1586 mothers who smoked occasionally or daily before pregnancy were included in the analysis. RESULTS The rate of smoking cessation during pregnancy was 53.0% (95% CI 50.3% to 55.7%). Higher pre-pregnancy smoking frequency, Inuit origin, being aged ≥ 35 years, lower education, not attending prenatal classes, lack of social support, stress before or during pregnancy, and living with a smoker were independently associated with higher risk of continued smoking, while First Nations (off-reserve) origin was associated with a lower risk. Among those who had quit smoking, 47.1% (95% CI 43.5% to 50.6%) relapsed postpartum. Living with a smoker, not having breastfed, and having stopped breastfeeding were independently associated with a higher risk of relapse. CONCLUSION This study highlights the need to tailor smoking cessation and prevention interventions for some high-risk groups of women.
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Greaves L, Hemsing N, Poole N, Bialystok L, O’Leary R. From fetal health to women’s health: expanding the gaze on intervening on smoking during pregnancy. CRITICAL PUBLIC HEALTH 2014. [DOI: 10.1080/09581596.2014.968527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chen LS, Baker TB, Piper ME, Smith SS, Gu C, Grucza RA, Smith GD, Munafo M, Bierut LJ. Interplay of genetic risk (CHRNA5) and environmental risk (partner smoking) on cigarette smoking reduction. Drug Alcohol Depend 2014; 143:36-43. [PMID: 25073833 PMCID: PMC4161618 DOI: 10.1016/j.drugalcdep.2014.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/19/2014] [Accepted: 06/01/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND This study tests whether the genetic predictor (CHRNA5 nicotine receptor gene variants) and an environmental risk factor (partner smoking) interact in the prediction of smoking reduction. METHODS Subjects were from a community-based, longitudinal study of women (n=1856) who smoked before pregnancy, and a randomized comparative effectiveness smoking cessation trial (n=1065). Smoking reduction was defined as the trajectory of self-reported smoking quantities over time in the observational study, and as the trajectory of alveolar CO levels in the cessation trial. RESULTS In the pregnancy study, rs16969968 genotype and partner smoking status interacted such that the smoking reduction was lowest for expectant mothers with high genetic risk and partner smoking, and highest for those with high genetic risk but not partner smoking (interaction of genotype×partner smoking on smoking quantity trajectory slope β=0.071, 95%CI=0.013, 0.13, p=0.017). In the clinical trial, a similar interaction was found (interaction β=0.20, 95%CI=0.049, 0.36, p=0.010). Furthermore, these associations were moderated by pharmacotherapy such that the interactive relation of genetic and environmental factors occurred in the placebo group, but not in the active pharmacotherapy group (interaction of genotype×partner smoking×pharmacotherapy on CO trajectory slope β=-0.25, 95%CI=-0.42, -0.091, p=0.0023). CONCLUSIONS The CHRNA5 genetic risk synergized the effect of partner smoking, producing an especially low likelihood of successful smoking reduction in two complementary studies. This suggests that the genetic vulnerability may be mitigated by altering environmental factors. In addition, cessation pharmacotherapy neutralizes the increase in cessation failure associated with combined genetic and environmental risks, which has possible relevance to treatment algorithms.
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Affiliation(s)
- Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, United States.
| | - Timothy B Baker
- Tobacco Research and Intervention, University of Wisconsin, School of Medicine, Madison, WI 53711, United States
| | - Megan E Piper
- Tobacco Research and Intervention, University of Wisconsin, School of Medicine, Madison, WI 53711, United States
| | - Stevens S Smith
- Tobacco Research and Intervention, University of Wisconsin, School of Medicine, Madison, WI 53711, United States
| | - Charles Gu
- Division of Biostatistics, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Richard A Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - George Davey Smith
- Avon Longitudinal Study of Parents and Children (ALSPAC), School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Marcus Munafo
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, United States
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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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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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