Ethnicity, maternal weight gain, and stress linked with postpartum smoking relapse
African-American women who stop smoking during their pregnancies are one-and-a-half to two times more likely than their Caucasian counterparts to relapse and resume smoking within a few months of giving birth, according to new research.
Suzan L. Carmichael, PhD, Indu B. Ahluwalia, MPH, PhD, and their colleagues also noted other relapse predictors besides ethnicity. These include previously having given birth, gaining more than 35 pounds during pregnancy, receiving inadequate prenatal care and counseling, experiencing numerous stressful events in the year preceding childbirth, and smoking intensively prior to pregnancy.
"All of these factors are similarly associated with a nearly two-fold increase in maternal postpartum smoking relapse," said Carmichael.
The researchers analyzed data gathered in 1996 from more than 15,000 postpartum women in 10 states who responded to questionnaires which were mailed two to six months after their babies were born. The study examined the prevalence and intensity of smoking (as measured by the mean number of cigarettes smoked each day) by women before and during their pregnancies and in the months immediately following childbirth.
The researchers report their findings in the October 2000 issue of the American Journal of Preventive Medicine.
African-American women were less likely than Caucasian women to smoke before they became pregnant, and both groups of women were equally likely to quit during their pregnancies. However, among women who quit smoking during pregnancy, African-American women were more likely than Caucasian women to relapse in the months following childbirth. This difference occurred despite the fact that African-American women reported smoking at a lower intensity than Caucasian women before pregnancy.
"Lower motivation to maintain a â€˜quitâ€™ status, differences in prenatal warnings about the hazards of smoking, different levels of nicotine in various cigarette brands, and additional social stresses could explain the higher relapse rate for African-American women," said Carmichael. In fact, women reporting five stressful events or more were nearly twice as likely to relapse into smoking than those who reported no stressful events.
Approximately one-quarter of all respondents reported that they smoked before they became pregnant, and nearly 45 percent of that group managed to stop smoking during their pregnancy. However, over half of the quitters had relapsed by the time they received the study questionnaire.
These results are consistent with the results of earlier studies, which indicate that 20 to 40 percent of women smokers quit during their pregnancies, but 50 to 80 percent of these ex-smokers relapse within six postpartum months.
"From a behavioral point of view, the relapse rate among postpartum women is surprising when compared to the relapse rate of the general smoking population," said Carmichael.
"Most pregnant women who manage to quit smoking do so early in their pregnancies and stop smoking until after their deliveries. They thus maintain their smoke-free status for a significant length of time," said Carmichael. "This long cessation period is usually associated with a lower relapse rate; yet postpartum women appear to be as susceptible to relapsing as non-pregnant individuals who have only just quit smoking."
The researchers point out that pregnant womenâ€™s concern for the health of their fetuses and desire to avoid social stigma are powerful motivators to abstain from smoking. It is possible, however, that many women in the study only intended to abstain from smoking for the duration of their pregnancies.
"Because smoking cessation is more likely to occur during pregnancy than at other times during a womanâ€™s childbearing years, it is hoped that determining which populations are most at risk for relapse can point the way to effective interventions that can help women maintain long-term smoking cessation," concludes Carmichael.
The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge, and wisdom in prevention science, education, practice, and policy. For more information about the Journal, contact the editorial office at (619) 594-7344.
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