Cluster subtypes appropriate for preventing postpartum smoking relapse

Abstract

Objective While the majority of women quit smoking either before or during pregnancy, 60 to 80% relapse in the postpartum period. The objective of this research was to examine postpartum women who quit smoking during their pregnancies and to determine the predictive factors for relapse in the postpartum period by identifying different subgroups that predict risk of relapse. Method One hundred forty four postpartum women who were abstinent at the time of delivery were recruited. Data regarding the Acquisition Stage of Change, Decisional Balance and Situational Temptations to Smoke were assessed in the immediate postpartum period. Based on their intention to remain abstinent, 121 women identified in the acquisition-Precontemplation (aPC) group comprised the study sample. Smoking status was assessed again at 2-months postpartum Results A cluster analysis was performed to idenitfy subgroups of the acquisition-Precontemplation (aPC) group. Four subgroups were identified and were labeled Most Protected, Ambivalent, Risk Denial, and High Risk. Logistic regression was performed to establish external validity of the clusters. The clusters and exclusive breastfeeding were the only statistically significant variables associated with relapse at 2-months postpartum. Conclusions The results confirmed the clusters identified in previous prevention research with both adolescents and postpartum women, The cluster profiles can serve to guide the development of a tailored intervention program.

A Content Analysis of Attributions for Resuming Smoking or Maintaining Abstinence in the Post-partum Period

“…Our results suggest that stress is consistently the most frequently cited contributor to post-partum smoking relapse, and this was a particularly relevant relapse factor for women who were younger, of lower income, and had more depressive symptoms. To that end, these results support the need to tailor intervention development for vulnerable sub-populations of pregnant women (38) and to incorporate stressors unique to the post-partum period, as well as social support networks, into the context of relapse prevention interventions (39)…”

A qualitative analysis of messages to promote smoking cessation among pregnant women

“…Future work could also explore how effectively the messages tested maintain smoke-free behaviour, particularly postpartum, when relapse is common. 6 20 35 …”

“…However, many continue to smoke during and beyond pregnancy, putting themselves and their children at risk. 5 6 …”

“… 12 The reported harms of smoking during pregnancy may diverge from their own experiences and the absence of overt or perceived harm may imply that continued smoking does not inevitably harm unborn children. 12–14 Women who smoke while pregnant (or who smoke following the birth of their child) may also see quitting as segregating them from social networks at the very time they would like greater support, 6 15 and report that smoking fosters social interactions, provides respite from monotonous jobs and represents opportunities to relax. 5 11 16–20 …”

Pediatric Office Delivery of Smoking Cessation Assistance for Breast-Feeding Mothers

“…8 The 2015 AAP Policy Statement on clinical practice policy to protect children from tobacco, nicotine, and tobacco smoke states that pediatricians should counsel and refer parents who smoke to resources to help them quit smoking and consider prescribing medication such as nicotine replacement therapy (NRT). 9 Studies have suggested that breast feeding is associated with a greater likelihood of smoking abstinence among mothers who had smoked, [10][11][12][13][14] and that early weaning is associated with postpartum smoking relapse. 10,15,16 A recent US study examining maternal attitudes of smoking and breast feeding showed smoking was not typically an influential factor in mothers' decisions to breast feed, but the majority of breast-feeding mothers who did consider the issue of smoking smoked less frequently or remained quit.…”