Risk Factors for Smoking Cessation Relapse After Pregnancy

1
Risk Factors for Smoking Cessation Relapse After
Pregnancy

• Elizabeth Clark, MD, MPH (1,2)
• Kenneth D. Rosenberg, MD, MPH (1, 3)
• (1) Oregon Health Science University,
  Portland, Oregon
• (2) University of Iowa College of
  Medicine, Iowa City, Iowa
• (3) Oregon DHS Office of Family Health,
  Portland, Oregon
• 9th Annual Maternal and Child Health Epidemiology
  Workshop, Tempe, AZ December 10, 2003

2
Introduction

• Maternal smoking associations
• Effects during Pregnancy
• Low Birth Weight (growth retardation)
• Effects in Infancy
• Increased SIDS
• Effects in Childhood and Adolescence
• Increased hyperactivity (ADHD)
• Increased alcohol drug use as adolescent
• Decreased child IQ
• Increased asthma

3
Methods

• Oregon PRAMS (Pregnancy Risk Assessment
  Monitoring System), 1998-99
• Stratified random sample of Oregon women a few
  months after live birth (from birth certificates)
• Response Rate 64.0 (1867/2917)
• Questions
• Smoking Before Pregnancy
• Smoking During Pregnancy (in the third
  trimester)
• Smoking After Pregnancy (at the time of the
  PRAMS survey)
• Days after birth mean106.5 Standard
  deviation27.2

4
Results

• 1867 women in sample
• 454 women (24.3) smoked before pregnancy
• 229 (50.4 of the smokers) successfully quit
  during pregnancy
• Among the 229 who successfully quit during
  pregnancy
• 91 (39.7) of the quitters relapsed after
  delivery
• 135 (59.0) of the quitters did not smoke after
  pregnancy (stayed quit)

5
Results Risk Factors for Relapse

• Among the women who quit smoking during
  pregnancy, risk factors for relapse (Odds Ratio,
  95 CI)
• 
  Bivariate Multivariate
• Living with other smokers 3.32 (1.38, 8.00)
  3.13 (1.28, 7.65)
• Multiparous 2.60 (1.10, 6.14) 2.28
  (0.94, 5.58)
• Medicaid (at LD) 2.24 (0.96, 5.23)
• Unmarried 1.83 (0.78, 4.32)
• Black race 1.55 (0.63, 3.80)
• Teen mother (

6
Conclusions

• Half of smoking women successfully quit smoking
  during pregnancy
• 60 of women who quit smoking during pregnancy
  were still quit at time of survey
• Women who lived with other smokers were less
  likely to stay quit

7
Discussion

• We found that living with other smokers is the
  strongest risk factor for relapse.
• Programs to decrease smoking among pregnant women
  should include partners
• Women are more likely to stay quit for their
  first baby than for subsequent babies.

8
Discussion

• Pregnant women who are internally motivated to
  quit (for themselves) are more likely to stay
  quit postpartum than women who are externally
  motivated to quit (for their baby)
• Stotts AL et al. Pregnancy smoking cessation a
  case of mistaken identity. Addictive Behaviors.
  199621459-471.

9
Discussion

• Limitations
• Mean time from delivery to survey is less than 4
  months (106.5 days) so stay-quit rate is higher
  than 6-month stay-quit rates (e.g., Mullen PD, et
  al. Maintenance of non-smoking postpartum by
  women who stopped smoking during pregnancy. Am J
  Public Health 199080992-994).
• Recall bias
• Strengths
• Survey method better than birth certificate or
  face-to-face interview

10
Public Health Implications

• More federal support for programs that help
  pregnant women quit and stay quit.
• Women who live with other smokers need extra
  social support to quit and stay quit.
• Replicate 5As Screening for prenatal care
  providers Ask, Advise, Assess, Assist, Arrange
  www.smokefreefamilies.org.
• Use of 5As can cause lower relapse rates at one
  year postpartum.
• Secker-Walker RH, et al. Amer J Prev
  Med199825-31

11
Acknowledgments

• Alfredo P. Sandoval
• Lesa Dixon-Gray