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Shevorykin A, Hyland BM, Robles D, Ji M, Vantucci D, Bensch L, Thorner H, Marion M, Liskiewicz A, Carl E, Ostroff JS, Sheffer CE. Tobacco use, trauma exposure and PTSD: a systematic review. Health Psychol Rev 2024:1-32. [PMID: 38711288 DOI: 10.1080/17437199.2024.2330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.
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Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget M Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniel Robles
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Mengjia Ji
- Department of Psychology, The City College of New York (CUNY), New York, NY, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Yakubu RA, Ajayi KV, Dhaurali S, Carvalho K, Kheyfets A, Lawrence BC, Amutah-Onukagha N. Investigating the Role of Race and Stressful Life Events on the Smoking Patterns of Pregnant and Postpartum Women in the United States: A Multistate Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) Analysis. Matern Child Health J 2023; 27:166-176. [PMID: 37737325 PMCID: PMC10692264 DOI: 10.1007/s10995-023-03773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To examine the smoking patterns of women who experienced stressful life events and the impact of racial disparities on the relationship between stressful life events, and prenatal/ postpartum smoking. METHODS The study analyzed data from the Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) survey across five states (CT, LA, MA, MO, WI). Four stressful life event categories were created using thirteen affiliated questions: financial, trauma, partner, and emotional. We assessed: 1) the association between smoking and stressful life events, 2) the impact of race on the relation between smoking and stressful life events, and 3) the long-term effects of smoking on health by assessing the association between smoking and maternal morbidity. Bivariate statistics and multivariate Poisson regression models were conducted. RESULTS A total of 24,209 women from five states were included. 8.9% of respondents reported smoking during pregnancy, and 12.7% reported smoking postpartum. There was a significant association between all stressful life events and smoking. Trauma stressful life event had the strongest association with smoking during pregnancy (adjusted PR=2.01; CI: 1.79-2.27) and postpartum (adjusted PR= 1.80; CI: 1.64-1.98). Race and stressful life event interaction effects on smoking had varied significant findings, but at least one racial/ ethnic minority group (Black, Hispanic, Asian) had a higher smoking prevalence than non-Hispanic White per stressful life event category. Lastly, the prevalence of maternal morbidity was higher for smoking during pregnancy (adjusted PR= 1.28; CI: 1.19-1.38) and postpartum (adjusted PR= 1.30; CI: 1.22-1.38) compared to no smoking. CONCLUSIONS FOR PRACTICE Culturally congruent, multi-disciplinary care teams are needed to address both clinical and social needs to reduce stressful life events and smoking. Screenings for stress should be standardized with a referral system in place to provide ongoing support.
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Affiliation(s)
- Rauta Aver Yakubu
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA.
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, 63104, USA.
| | - Kobi V Ajayi
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- Texas A&M University, College Station, TX, 77845, USA
| | - Shubhecchha Dhaurali
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- School of Arts & Sciences, Tufts University, Medford, MA, 02155, USA
| | - Keri Carvalho
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Anna Kheyfets
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- School of Medicine, Tufts University, Boston, MA, 02111, USA
| | - Blessing Chidiuto Lawrence
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Ndidiamaka Amutah-Onukagha
- Maternal Outcomes for Translational Health Equity Research (M.O.T.H.E.R) Lab, Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, 02111, USA
- School of Medicine, Tufts University, Boston, MA, 02111, USA
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Thomas SA, Clements-Nolle KD, Wagner KD, Omaye S, Lu M, Yang W. Adverse childhood experiences, antenatal stressful life events, and marijuana use during pregnancy: A population-based study. Prev Med 2023; 174:107656. [PMID: 37543311 DOI: 10.1016/j.ypmed.2023.107656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/22/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
Cumulative exposure to adverse childhood experiences (ACEs) and antenatal stressful life events (ASLEs) are independently associated with marijuana use during pregnancy. However, research has not explored how both exposures may influence marijuana use jointly. Assessing the joint associations of ACEs and recent ASLEs on marijuana use can identify people who may benefit from early intervention. Data come from the Nevada Pregnancy Risk Assessment Monitoring System, 2017-2020 (N = 2483). We assessed eight measures of ACEs before age 18 and fourteen measures of ASLEs twelve months before giving birth. Generalized estimating equations estimated the direct and joint associations (additive and multiplicative interaction) of ACEs and ASLEs on marijuana use during pregnancy. 9.8% used marijuana during the most recent pregnancy. Compared to people who reported no ACEs, those reporting 1 ACE (adjusted prevalence ratio[aPR] = 1.96, 95% confidence interval [CI] = 1.30-2.94), 3 ACEs (aPR = 3.58, 95%CI = 2.69-4.77), and 4+ ACEs (aPR = 3.67, 95%CI = 2.36-5.72) were more likely to use marijuana. Compared to people reporting no ASLEs, those reporting 4+ ASLEs (aPR = 3.12, 95% CI = 1.64-5.92) were more likely to use marijuana. There was evidence of interaction for high ACE and ASLE exposure on an additive scale. ACEs and ASLEs were independently associated with marijuana use during pregnancy, and there was evidence of additive interaction. Screening for ACEs and ASLEs during pregnancy, referrals to appropriate behavioral health services, and trauma-informed approaches are important to address marijuana use during pregnancy.
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Affiliation(s)
- Shawn A Thomas
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV 89557, USA.
| | - Kristen D Clements-Nolle
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV 89557, USA
| | - Karla D Wagner
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV 89557, USA
| | - Stanley Omaye
- College of Agriculture, Biotechnology, & Natural Resources, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV 89557, USA
| | - Minggen Lu
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV 89557, USA
| | - Wei Yang
- School of Public Health, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV 89557, USA
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Rokicki S, Reichman NE, McGovern ME. Association of Increasing the Minimum Wage in the US With Experiences of Maternal Stressful Life Events. JAMA Netw Open 2023; 6:e2324018. [PMID: 37462972 PMCID: PMC10354676 DOI: 10.1001/jamanetworkopen.2023.24018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/04/2023] [Indexed: 07/21/2023] Open
Abstract
Importance Exposure to stressful life events (SLEs) before and during pregnancy is associated with adverse health for pregnant people and their children. Minimum wage policies have the potential to reduce exposure to SLEs among socioeconomically disadvantaged pregnant people. Objective To examine the association of increasing the minimum wage with experience of maternal SLEs. Design, Setting, and Participants This repeated cross-sectional study included 199 308 individuals who gave birth between January 1, 2004, and December 31, 2015, in 39 states that participated in at least 2 years of the Pregnancy Risk Assessment Monitoring Survey between 2004 and 2015. Statistical analysis was performed from September 1, 2022, to January 6, 2023. Exposure The mean minimum wage in the 2 years prior to the month and year of delivery in an individual's state of residence. Main Outcomes and Measures The main outcomes were number of financial, partner-related, traumatic, and total SLEs in the 12 months before delivery. Individual-level covariates included age, race and ethnicity, marital status, parity, educational level, and birth month. State-level covariates included unemployment, gross state product, uninsurance, poverty, state income supports, political affiliation of governor, and Medicaid eligibility levels. A 2-way fixed-effects analysis was conducted, adjusting for individual and state-level covariates and state-specific time trends. Results Of the 199 308 women (mean [SD] age at delivery, 25.7 [6.1] years) in the study, 1.4% were American Indian or Alaska Native, 2.5% were Asian or Pacific Islander, 27.2% were Hispanic, 17.6% were non-Hispanic Black, and 48.8% were non-Hispanic White. A $1 increase in the minimum wage was associated with a reduction in total SLEs (-0.060; 95% CI, -0.095 to -0.024), financial SLEs (-0.032; 95% CI, -0.056 to -0.007), and partner-related SLEs (-0.019; 95% CI, -0.036 to -0.003). When stratifying by race and ethnicity, minimum wage increases were associated with larger reductions in total SLEs for Hispanic women (-0.125; 95% CI, -0.242 to -0.009). Conclusions and Relevance In this repeated cross-sectional study of women with a high school education or less across 39 states, an increase in the state-level minimum wage was associated with reductions in experiences of maternal SLEs. Findings support the potential of increasing the minimum wage as a policy for improving maternal well-being among socioeconomically disadvantaged pregnant people. These findings have relevance for current policy debates regarding the minimum wage as a tool for improving population health.
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Affiliation(s)
- Slawa Rokicki
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Nancy E. Reichman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Economics, Princeton University, Princeton, New Jersey
| | - Mark E. McGovern
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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Testa A, Jackson DB, Simon L, Ganson KT, Nagata JM. Stressful life events, oral health, and barriers to dental care during pregnancy. J Public Health Dent 2023; 83:275-283. [PMID: 37294070 DOI: 10.1111/jphd.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/02/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Poor oral health during pregnancy poses risks to maternal and infant well-being. However, limited research has documented how proximate stressful life events (SLEs) during the prenatal period are associated with oral health and patterns of dental care utilization. METHODS Data come from 13 states that included questions on SLEs, oral health, and dental care utilization in the Pregnancy Risk Assessment Monitoring System for the years 2016-2020 (n = 48,658). Multiple logistic regression analyses were used to assess the association between levels of SLE (0, 1-2, 3-5, or 6+) and a range of (1) oral health experiences and (2) barriers to dental care during pregnancy while controlling for socio-demographic and pregnancy-related characteristics. RESULTS Women with more SLEs in the 12 months before birth-especially six or more-reported worse oral health experiences, including not having dental insurance, not having a dental cleaning, not knowing the importance of caring for teeth and gums, needing to see a dentist for a problem, going to see a dentist for a problem, and unmet dental care needs. Higher levels of SLEs were also associated with elevated odds of reporting barriers to dental care. CONCLUSIONS SLEs are an essential but often understudied risk factor for poor oral health, unmet dental care needs, and barriers to dental care services. Future research is needed to understand better the mechanisms linking SLEs and oral health.
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Affiliation(s)
- Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Simon
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, California, USA
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De Genna NM, Qu Y, Cheng Y, Emery Tavernier RL, Kolko Conlon RP, Levine MD. Trajectories of Return to Cigarette Smoking Up to 1 Year Postpartum Among People Who Quit Smoking During Pregnancy. Nicotine Tob Res 2023; 25:875-881. [PMID: 36402742 PMCID: PMC10077935 DOI: 10.1093/ntr/ntac263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/03/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Previous work has identified predictors of relapse to smoking postpartum among parenting people who quit during pregnancy, but less is known about the time course of postpartum relapse. The study goals were to document patterns and correlates of smoking resumption among people who quit smoking during pregnancy and were motivated to remain abstinent. AIMS AND METHODS We conducted a secondary analysis among participants in a randomized controlled trial of postpartum-specific smoking relapse prevention interventions who self-reported no smoking since the quit date to delivery (n = 280). Participants provided expired air samples of carbon monoxide, and completed self-report measures of mood, perceived stress, and demographic and pregnancy-related information. Timeline follow-back interviews were conducted at the end of pregnancy and 12-, 24-, and 52-weeks postpartum. RESULTS The largest group (49.7% of participants) belonged to a trajectory reflecting abstinence across 1 year postpartum. Another 13% remained abstinent 5-6 months after delivery. However, one in five started to smoke consistently within 100 days after delivery, and 16% relapsed in a pattern that can be described as inconsistent smoking. Participants with more prior quit attempts and those who smoked more cigarettes prior to their quit attempt were more likely to relapse within 100 days of delivery. CONCLUSIONS The first 3 months postpartum represent a critical window for relapse prevention, given that most individuals who relapsed did so in the first 100 days or so after delivery. Assessing prior smoking history can help identify pregnant people who will need additional support in the early postpartum period. IMPLICATIONS Relapse to smoking during the year after childbirth is common, but the time course of relapse after delivery is poorly understood. This study provides evidence for 4 distinct trajectories of relapse, and highlights variables linked to early relapse that may improve efforts to target and time intervention efforts. Specifically, assessing age at initiation, quantity of tobacco use prior to quit attempt, and number of previous quit attempts will identify pregnant people at greatest risk of early relapse. These findings also suggest that additional support early in the postpartum period is crucial for most people in the postpartum who will relapse.
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Affiliation(s)
- Natacha M De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine and Department of Epidemiology, University of Pittsburgh School of Public Health, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Yang Qu
- Department of Statistics, University of Pittsburgh, 1818 Wesley W. Posvar Hall, Pittsburgh, PA 15213, USA
| | - Yu Cheng
- Department of Statistics, University of Pittsburgh, 1818 Wesley W. Posvar Hall, Pittsburgh, PA 15213, USA
| | - Rebecca L Emery Tavernier
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, 141 Smed. 1035 University Drive, Duluth, MN 55812-303, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Michele D Levine
- Departments of Psychiatry, Psychology, and Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Department of Psychology, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
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Derksen ME, Jaspers MWM, Kunst AE, Fransen MP. Usage of digital, social and goal-setting functionalities to support health behavior change: A mixed methods study among disadvantaged women during or after pregnancy and their healthcare professionals. Int J Med Inform 2023; 170:104981. [PMID: 36603389 DOI: 10.1016/j.ijmedinf.2022.104981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/26/2022] [Accepted: 12/28/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We aimed to gain insight into how and to what extent social (i.e. private/group chat) and goal-setting (e.g. rewards) functionalities in digital interventions for health behavior change were used by clients and nurses in a preventive care program for disadvantaged women during or after pregnancy, and which factors influenced usage. METHODS We collected quantitative and qualitative data on usage of these functionalities in 'Kindle', a mHealth intervention to prepare for health behavior change. RESULTS We found that nurses (n = 5) and clients (n = 20) scarcely used both functionalities. They sent 862 messages in the social functionality whose security they appreciated, but habitually used WhatsApp likewise. Moreover, nurses were hesitant to let their clients interact in the group chat. Clients formulated 59 personal goals, which they found difficult to do. Nurses rewarded 846 points for clients' progress on goal attainment, but found it hard to determine how many points to reward. Clients and nurses indicated that the functionality made it more fun and easy to discuss clients' personal goals. CONCLUSIONS To conclude, digital, social and goal-setting functionalities were used to a limited extent by nurses and clients, and need optimization before implementation to support disadvantaged groups to change their health behavior.
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Affiliation(s)
- M E Derksen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
| | - M W M Jaspers
- Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - A E Kunst
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - M P Fransen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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Testa A, Crawford AD, Jackson DB, Gemmill A. Stressful life events and prescription opioid use during pregnancy: findings from the 2019 pregnancy risk assessment monitoring system. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2181-91. [PMID: 35947167 DOI: 10.1007/s00127-022-02349-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Prescription opioid use during pregnancy poses risk to maternal and infant health. However, there is limited research on proximate risk factors for prescription opioid use during pregnancy. This study aimed to evaluate the relationship between stressful life events experienced in the 12 months prior to birth and prescription opioid use during pregnancy. METHODS Data from the 2019 Pregnancy Risk Assessment Monitoring System were analyzed (N = 17,812 women who delivered a live birth in 2019). Logistic regression and multinomial logistic regression analyses were used to assess the association between levels of stressful life events (0, 1-2, 3-5, or 6+) on (1) prescription opioid use, (2) combined opioid use (mono- or poly-opioid use), and (3) patterns of opioid use (pain management, opioid misuse) during pregnancy while controlling for socio-demographic characteristics, patterns of substance use prior to pregnancy, and pregnancy-related characteristics. RESULTS Women with a greater accumulation of stressful life events in the 12 months prior to birth-especially 6 or more-had increased likelihood of prescription opioid use. Accumulating stressful life events were also associated with a higher risk of poly-opioid use, as well as using prescription opioids for pain management and patterns of opioid misuse. CONCLUSION Stressful life events are a risk factor for prescription opioid use during pregnancy. Considering the harms posed by both stressors and opioid use for maternal and infant wellbeing, future research should assess efforts to prevent and manage stressful life events to reduce opioid use during pregnancy.
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Buehler C, Girod SA, Leerkes EM, Bailes L, Shriver LH, Wideman L. Women's Social Well-Being During Pregnancy: Adverse Childhood Experiences and Recent Life Events. Womens Health Rep (New Rochelle) 2022; 3:582-592. [PMID: 35814611 PMCID: PMC9258794 DOI: 10.1089/whr.2022.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Adverse experiences during childhood and recent stressful life events are each associated with women's reduced well-being and poorer health during pregnancy. Few studies, however, have focused upon pregnant women's social well-being, and inclusion of both independent variables in the same analysis is rare. This study focuses upon adverse experiences during childhood as well as recent life events in relationship to four aspects of social well-being: social support, couple aggression for partnered women, neighborhood safety, and food insecurity. MATERIALS AND METHODS A diverse community sample of 176 pregnant women completed questionnaires during their third trimester. A cross-sectional design was used that included retrospective reports of childhood experiences, as well as reports of recent life events and current well-being. RESULTS Adverse experiences during childhood were uniquely associated with couple aggression (β = 0.206, p = 0.026) and lower neighborhood safety (β = -0.185, p = 0.021). Recent stressful life events were uniquely associated with lower social support (β = -0.247, p = 0.001) and greater food insecurity (β = 0.494, p = 0.000). For social support and food insecurity, there was a significant indirect pathway from adverse childhood experiences through recent stressful life events. Adverse child experiences and recent stressful life events did not interact. CONCLUSIONS A life-course perspective that considers women's experiences across their life span is critical for use by both researchers and health practitioners. Adverse childhood experiences and recent stressful life events are important for understanding social features of pregnant women's daily lives.
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Affiliation(s)
- Cheryl Buehler
- Department of Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Savannah A. Girod
- Department of Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Esther M. Leerkes
- Department of Human Development and Family Studies, University of North Carolina Greensboro, Greensboro, North Carolina, USA
- School of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Lauren Bailes
- Department of Psychological Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Lenka H. Shriver
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina Greensboro, Greensboro, North Carolina, USA
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Testa A, Fahmy C, Jackson DB. Incarceration exposure and prescription opioid use during pregnancy. Drug Alcohol Depend 2022; 235:109434. [PMID: 35405460 DOI: 10.1016/j.drugalcdep.2022.109434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prior research demonstrates a high prevalence of substance use, including opioid use, among those who have had personal or vicarious contact with the correctional system. Relatedly, alongside patterns of rising opioid use in general, opioid use during pregnancy is becoming a growing public health concern. Still, risk factors for prescription opioid use during pregnancy remain understudied. This study is the first to assess the connection between a women's personal or vicarious exposure to incarceration in the 12 months prior to birth and patterns of prenatal opioid use. METHODS Data are from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2019 (N = 17,551 mothers). Logistic and multinomial logistic regression are used to assess the association between incarceration exposure and patterns of opioid use during pregnancy. RESULTS Incarceration-exposed women were more likely to use all eight types of prescription opioids assessed in this study (Hydrocodone, Codeine, Oxycodone, Tramadol, Hydromorphone/Meperidine, Oxymorphone, Morphine, and Fentanyl). After adjustment for control variables, incarceration-exposed women were significantly more likely to report any prescription opioid use during pregnancy (OR = 1.745, 95% CI = 1.194, 2.554). Furthermore, relative to no opioid use, incarceration exposure was also associated with illicit prescription opioid use (RRR = 2.979, 1.533, 5.791). CONCLUSIONS Incarceration exposure in the year prior to birth is associated with higher odds of prescription opioid use. These findings add to the burgeoning literature that details a women's exposure to incarceration is a risk marker for substance use and engagement in health risk behaviors that can jeopardize maternal and infant wellbeing.
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Alexander AC, Waring JJ, Olurotimi O, Kurien J, Noble B, Businelle MS, Ra CK, Ehlke SJ, Boozary LK, Cohn AM, Kendzor DE. The relations between discrimination, stressful life events, and substance use among adults experiencing homelessness. Stress Health 2022; 38:79-89. [PMID: 34137166 PMCID: PMC9629914 DOI: 10.1002/smi.3073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/03/2023]
Abstract
The current study investigated whether stressful life events and everyday discrimination experiences were associated with using one or more substances in the past 30-days and substance use disorder (SUD) among adults experiencing homelessness. We obtained survey data from adults (N = 501) seeking services at a day shelter. Participants self-reported whether they used cigarettes, other tobacco products, cannabis, alcohol, opioids, amphetamine, and cocaine/crack in the past 30-days, and the total number of substances used were also calculated. We measured stressful life events and everyday discrimination using validated scales. We used multivariable logistic and negative binomial regression analyses to evaluate hypothesised associations. Results indicated that reporting a higher number of stressful life events was associated with past 30-days cannabis, tobacco, alcohol, and other substance use, screening positive for a SUD, and using a greater number of substances in the past 30 days. After accounting for stressful life events, everyday discrimination was associated with only past 30-days cannabis use. Overall, we found that reporting stressful life events was related to current substance use and screening positive for a SUD. Findings suggest that life stressors, and discrimination to a lesser extent, were associated with substance use and SUD among adults experiencing homelessness.
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Affiliation(s)
- Adam C. Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joseph J.C. Waring
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Oluwakemi Olurotimi
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Jasmin Kurien
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Bishop Noble
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Chaelin K. Ra
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Sarah J. Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Laili K. Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Psychology, Cellular and Behavioral Neurobiology, The University of Oklahoma, Norman, OK
| | - Amy M. Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Gailey S, Knudsen ES, Mortensen LH, Bruckner TA. Birth outcomes following unexpected job loss: a matched-sibling design. Int J Epidemiol 2021; 51:858-869. [PMID: 34508593 DOI: 10.1093/ije/dyab180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research documents social and economic antecedents of adverse birth outcomes, which may include involuntary job loss. Previous work on job loss and adverse birth outcomes, however, lacks high-quality individual data on, and variation in, plausibly exogenous job loss during pregnancy and therefore cannot rule out strong confounding. METHODS We analysed unique linked registries in Denmark, from 1980 to 2017, to examine whether a father's involuntary job loss during his spouse's pregnancy increases the risk of a low-weight (i.e. <2500 grams) and/or preterm (i.e. <37 weeks of gestational age) birth. We applied a matched-sibling design to 743 574 sibling pairs. RESULTS Results indicate an increased risk of a low-weight birth among infants exposed in utero to fathers' unexpected job loss [odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.07, 1.75]. Sex-specific analyses show that this result holds for males (OR = 1.70, 95% CI: 1.14, 2.53) but not females (OR = 1.24, 95% CI: 0.80, 1.91). We find no relation with preterm birth. CONCLUSIONS Findings support the inference that a father's unexpected job loss adversely affects the course of pregnancy, especially among males exposed in utero.
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Affiliation(s)
- Samantha Gailey
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | - Elias Stapput Knudsen
- Department of Technology, Management, and Economics, Technical University of Denmark, Copenhagen, Denmark
| | - Laust H Mortensen
- Denmark Statistics, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tim A Bruckner
- Program in Public Health, University of California Irvine, Irvine, CA, USA.,Center for Population, Inequality, and Policy, University of California Irvine, Irvine, CA, USA
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13
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Khorrami Z, Zolala F, Haghdoost A, Sadatmoosavi A, Ben Taleb Z, Kondracki A, Ward KD, Shahbaz M, Ebrahimi Kalan M. Job-related stress and tobacco smoking: A systematic review. Journal of Workplace Behavioral Health 2021. [DOI: 10.1080/15555240.2021.1960854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Zahra Khorrami
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Zolala
- Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - AliAkbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Sadatmoosavi
- Department of Medical Library & Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas, Arlington, Texas, USA
| | - Anthony Kondracki
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Mohammad Shahbaz
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
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14
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Pereira G, Dunne J, Regan AK, Tessema GA. Smoking Cessation and Preterm Birth in Second Pregnancy Among Women who Smoked in Their First. Nicotine Tob Res 2021; 23:2013-2018. [PMID: 34297840 DOI: 10.1093/ntr/ntab135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The benefit of smoking cessation in reducing the risk of preterm birth is well established. Relatively less well understood is the prevalence of smoking cessation maintenance at the next pregnancy and the associated preterm risk reduction. The aim of this study was to estimate the prevalence of maintenance of smoking cessation at second pregnancy and the associated relative risk of preterm birth. METHODS This was a longitudinal study with retrospectively obtained records of births to multiparous women who smoked in the pregnancy of their first birth in New South Wales, 1994-2016 (N = 63 195 mothers). Relative risks (RR) of preterm birth of the second child were estimated for smoking cessation with adjustment for final gestational age of the first birth, maternal age at the first birth, change in socioeconomic disadvantage between the first and second pregnancy, interpregnancy interval, and calendar time. RESULTS Approximately 34% (N = 21 540) of women who smoked during their first pregnancy did not smoke in the second pregnancy. Smoking cessation among women who smoked at first pregnancy was associated with a 26% (95% CI: 21%, 31%) decrease in risk of preterm birth at a second pregnancy. CONCLUSION Despite smoking during the first pregnancy, smoking cessation was achieved and maintained by more than one-third of women in their second pregnancy with encouraging levels of preterm risk reduction. It is well-established that the period after birth provides an opportunity to reduce smoking-related morbidity for both the mother and neonate. Our results indicate that this period also offers an opportunity to prevent morbidity of future pregnancy. IMPLICATIONS A considerable amount of research has been undertaken on the effects of smoking during pregnancy on birth outcomes, the influence of postpartum smoking on the health of the mother and newborn child, and postpartum smoking cessation. However, follow-up of women after giving birth does not tend to be long enough to observe smoking and outcomes of subsequent pregnancies. We show that smoking cessation in the subsequent pregnancy is achievable by a large proportion of women despite smoking in their first pregnancy, which translates to clear reductions in risk of preterm birth in the subsequent pregnancy.
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Affiliation(s)
- Gavin Pereira
- Curtin School of Population Health, Curtin University, WA, Australia.,Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Jennifer Dunne
- Curtin School of Population Health, Curtin University, WA, Australia
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, WA, Australia.,School of Nursing and Health Professions, University of San Francisco, San Fransisco, CA, USA
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15
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Kedia SK, Ahuja NA, Carswell A, Vander Weg MW, Scarinci IC, Ward KD. Smoking Cessation among Pregnant and Postpartum Women from Low-Income Groups in the United States. J Midwifery Womens Health 2021; 66:486-493. [PMID: 34260136 DOI: 10.1111/jmwh.13242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pregnancy creates a unique window of opportunity for smoking cessation. However, pregnant women from underserved groups can face personal, social, and environmental challenges that impede quitting. This study draws upon the socioecological framework to explore perspectives on smoking cessation among pregnant and postpartum women from low-income groups in the mid-South of the United States. METHODS Semistructured interviews were conducted with 60 women who were pregnant or postpartum. Data were analyzed in Dedoose qualitative software using the directed content analysis approach. RESULTS Findings reveal that at the individual level, motivations for smoking cessation included the fact of being pregnant, risks associated with the infant's health, and desire to breastfeed. However, some pregnant women perceived that slowing down on smoking during pregnancy was adequate to prevent harm to their fetuses. Individual-level factors that made smoking cessation difficult included nicotine addiction and habit, boredom, stressful life circumstances, fear of weight gain, and perceived lack of willpower. At the interpersonal level, living in a smoke-free environment where loved ones do not smoke and emotional and practical support from social network members including partners and family members were thought to facilitate smoking cessation. At the organizational level, access to nicotine replacement therapies and counseling aided in their abilities to quit smoking. At the policy level, pregnant women viewed increase in cigarette prices, warning labels on the cigarette pack, and the potential for a ban on cigarette sales as having some effect in helping them quit smoking. DISCUSSION This study offers theoretical insights into factors that function as barriers or facilitators of smoking cessation among pregnant and postpartum women from low-income groups in the United States. Designing multilevel smoking cessation interventions while considering the interplay of individual, interpersonal, organizational, and policy level factors may lead to better cessation outcomes.
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Affiliation(s)
- Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Nikhil A Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
| | | | - Mark W Vander Weg
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa.,Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
| | - Isabel C Scarinci
- Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
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16
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Amiri S, Saadat SH. Smoking and Smoking Relapse in Postpartum: A Systematic Review and Meta-analysis. Addictive Disorders & Their Treatment 2021; 20:486-499. [DOI: 10.1097/adt.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
RATIONALE Smoking during pregnancy poses a significant health risk for infant well-being. Prior research has linked experiencing stressful life events (SLEs) during pregnancy to prenatal smoking. However, extant research has not assessed whether SLEs experienced during pregnancy are a risk factor for prenatal electronic cigarette use. OBJECTIVE This study investigates the association between SLEs and electronic cigarette use during the third trimester of pregnancy. METHODS We employ data on 70,626 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic and multinomial logistic regression models were used to examine the association between SLEs and electronic cigarette use during the third-trimester of pregnancy. RESULTS The prevalence of electronic cigarette use increased alongside an accumulating history of SLEs (0 SLEs = 0.4%; 1-2 SLEs = 0.9%; 3-5 SLEs = 1.9%; 6+ SLEs = 5.0%). Logistic regression models found 6 or more SLEs were associated with 4.7 times higher odds of electronic cigarette use relative to 0 SLEs after adjusting for demographic and socioeconomic characteristics (AOR = 4.705, 95% CI = 2.960, 7.479). Study findings also showed that women who experienced greater levels of SLEs had a higher prevalence of using any nicotine products (i.e., exclusive electronic cigarette user, exclusive cigarette user, dual user), relative to being a non-smoker. Findings from multinomial logistic regression models revealed that a higher number of SLEs was associated with an increased relative risk of all smoking outcomes. Still, these associations were particularly pronounced in the case of exclusive electronic cigarette user (ARR = 8.485, 95% CI = 4.900, 14.692) and dual-use (ARR = 8.348, 95% CI = 4.113, 16.945) when participants experienced 6 or more SLEs (relative to 0 SLEs). CONCLUSIONS Considering the potentially harmful ramifications of electronic cigarette use during pregnancy there is a need for interventions that reduce stressful experiences and decrease smoking during pregnancy.
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Affiliation(s)
- Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA.
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cashen Boccio
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA
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18
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Tagai EK, Miller SM, Belfiglio A, Xu J, Wen KY, Hernandez E. Persistent Barriers to Smoking Cessation Among Urban, Underserved Women: A Feasibility Study of Tailored Barriers Text Messages. Matern Child Health J 2020; 24:1308-1317. [PMID: 32557133 DOI: 10.1007/s10995-020-02963-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Despite health risks for themselves and their children, urban underserved women smoke at high rates postpartum. The postpartum period is a stressful transition time that presents unique barriers to sustained cessation. There is limited extant evidence of efficacious psychosocial programs to maintain postpartum smoking cessation. METHODS Guided by the Cognitive-Social Health Information Processing model, we explored the feasibility of TxT2Commit, a text-messaging intervention designed to prevent postpartum smoking relapse. Participants (n = 43) received supportive cessation-focused text messages for one month postpartum. Using a convergent mixed method design, surveys and interviews assessed changes in psychosocial factors and smoking status through a three month follow-up. RESULTS Participants reported satisfaction with TxT2Commit, rating text messages as helpful, understandable, supportive, and not bothersome. However, a majority of women (n = 28, 65.1%) relapsed by three months. Participants who stayed smoke free (i.e., non-relapsers) reported significantly less temptation to smoke at one and three months postpartum compared to relapsers (ps < .01). While relapsers had significantly less temptation at one month compared to baseline, temptation increased by three months (p < .01). Consistent with the quantitative results, qualitative interviews identified informational and coping needs, with continued temptation throughout the three months. Non-relapsers were able to manage temptation and reported greater support. CONCLUSIONS FOR PRACTICE TxT2Commit demonstrates preliminary feasibility and acceptability among urban, underserved postpartum women. However, most participants relapsed by three months postpartum. Additional research is needed to identify targeted messaging to best help women avoid temptation and bolster support to stay smoke free in this uniquely stressful period.
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Affiliation(s)
- E K Tagai
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - S M Miller
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - A Belfiglio
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - J Xu
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - K Y Wen
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
- Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, Suite 314, Philadelphia, PA, 19107, USA
| | - E Hernandez
- Obstetrics, Gynecology, and Reproductive Sciences, Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Philadelphia, PA, 19410, USA
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Allenby C, Falcone M, Ashare RL, Cao W, Bernardo L, Wileyto EP, Pruessner J, Loughead J, Lerman C. Brain Marker Links Stress and Nicotine Abstinence. Nicotine Tob Res 2020; 22:885-891. [PMID: 31120113 DOI: 10.1093/ntr/ntz077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Subjective stress is a well-documented predictor of early smoking relapse, yet our understanding of stress and tobacco use is limited by reliance on self-reported measures of stress. We utilized a validated functional neuroimaging paradigm to examine whether stress exposure during early abstinence alters objective measures of brain function. METHODS Seventy-five participants underwent blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) during the Montreal Imaging Stress Task (MIST) on two occasions: once during smoking satiety and once following biochemically confirmed 24-hour abstinence (order counterbalanced). The primary outcome measure was brain response during stress (vs. control) blocks of the MIST, assessed using whole-brain analysis corrected for multiple comparisons using clusters determined by Z ≥ 3.1. RESULTS Abstinence (vs. satiety) was associated with significantly increased activation in the left inferior frontal gyrus, a brain region associated with inhibitory control. Abstinence-induced change in brain response to stress was positively associated with change in self-reported stress. CONCLUSIONS This study provides objective evidence that the brain response to stress is altered during the first 24 hours of a quit attempt compared to smoking satiety. IMPLICATIONS These results point to the potential value of inoculating smokers with stress management training prior to a quit attempt.
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Affiliation(s)
- Cheyenne Allenby
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Mary Falcone
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Wen Cao
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Leah Bernardo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Jens Pruessner
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - James Loughead
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Caryn Lerman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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Allen AM, Jung AM, Alexander AC, Allen SS, Ward KD, al’Absi M. Cannabis use and stressful life events during the perinatal period: cross-sectional results from Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2016. Addiction 2020; 115:1707-1716. [PMID: 32032979 PMCID: PMC9219169 DOI: 10.1111/add.15003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/11/2019] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
AIMS We aimed to determine the association between stressful life events (SLEs) in the year prior to childbirth with (1) pre-pregnancy cannabis use, (2) cessation of cannabis use during pregnancy and (3) postpartum relapse to cannabis use. DESIGN We used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016, a cross-sectional, population-based surveillance system. SETTING Mailed and telephone surveys conducted in five states-Alaska, Colorado, Maine, Michigan and Washington-in the United States. PARTICIPANTS Women (n = 6061) who delivered a live infant within the last 6 months and had data on cannabis use. MEASUREMENTS Self-reported data included SLEs (yes/no response for 14 individual events in the 12 months prior to childbirth) and cannabis use [yes/no prior to pregnancy, during pregnancy, and at the time of the survey (approximately 2-6 months postpartum)]. The associations between SLEs and cannabis use (primary outcomes) were examined in logistic regression models adjusted for maternal demographics (e.g. age, race, education), geography (i.e. state of residence) and cigarette smoking. FINDINGS Pre-pregnancy, 16.4% (997/6061) of respondents endorsed using cannabis, with 36.4% (363/997) continuing cannabis use during pregnancy. Among the 63.6% (634/997) who did not report use during pregnancy, 23.2% (147/634) relapsed to cannabis use during the postpartum. Nine of the 14 possible SLEs were associated with increased odds of pre-pregnancy cannabis use [e.g. husband/partner or mother went to jail, adjusted odds ratio (aOR) = 2.16, 95% confidence interval (CI) = 1.30-3.62] and four were associated with increased odds of continued cannabis use during pregnancy (e.g. husband/partner lost job, aOR = 2.19, 95% CI = 1.21-3.96). The odds of postpartum relapse to cannabis were significantly associated with two SLEs (husband/partner said they did not want pregnancy, aOR = 2.86, CI = 1.10-7.72; husband/partner or mother went to jail, aOR = 0.37, 95% CI = 0.13-1.00). CONCLUSIONS Stressful life events during the year prior to childbirth appear to be linked to greater odds of women's cannabis use during the perinatal period, especially during pre-pregnancy.
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Affiliation(s)
- Alicia M. Allen
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Alesia M. Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Adam C. Alexander
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sharon S. Allen
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Mustafa al’Absi
- Department of Family Medicine and Biobehavioral Health, Medical School, University of Minnesota, Duluth, MN, USA
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Alashoor T, Han S. The smoking paradox: exploring why attitudes toward cigarette smoking are a weak predictor of cigarette smoking. Psychol Health 2020; 36:847-861. [PMID: 32862721 DOI: 10.1080/08870446.2020.1798958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE An attitude change perspective represents a central line of research in the smoking literature. This line of research focuses on influencing individuals' attitudes toward smoking in order to alleviate the negative outcomes of smoking and to achieve positive smoking behaviours. This line of research, however, does not explain why attitudes toward cigarette smoking are a weak predictor of cigarette smoking, an indication of a smoking paradox. The current study introduces two domain-general factors to explore this smoking paradox. DESIGN We used an online survey and collected data from American subjects (n = 328) via a crowdsourcing platform, Amazon Mechanical Turk, in 2018. RESULTS We found that the association between attitude toward smoking and the likelihood of smoking is significantly weaker when individuals perceive a low probability of risk and/or believe that this probable risk will only occur in the distant future, after many years. These results suggest that smoking may not be consistent with attitude because individuals perceive low probability of risk and/or they temporally discount the occurrence of this probable risk. CONCLUSION The results suggest that novel strategies that incorporate the concepts of perceived risk probability and temporal discounting of the probable risk are needed for smoking cessation.
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Affiliation(s)
- Tawfiq Alashoor
- Information Technology, Analytics, and Operations, Mendoza College of Business, University of Notre Dame, Notre Dame, IN, USA.,Information Systems & Operations Management, KFUPM Business School, King Fahd University of Petroleum and Minerals, Dhahran, Saudi Arabia
| | - Sehee Han
- Institute of Social Sciences, Kookmin University, Seongbok-gu, South Korea
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22
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Perdriolle-Galet E, Peyronnet V, Bertholdt C. [Management of Resumption Risk in Postpartum for Women who Quit Smoking During Pregnancy - CNGOF-SFT Expert Report and Guidelines for Smoking Management During Pregnancy]. Gynecol Obstet Fertil Senol 2020; 48:619-624. [PMID: 32247855 DOI: 10.1016/j.gofs.2020.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
According to the 2016 National Perinatal Survey, 30.0 % of women smoked before pregnancy, 45.8 % quit smoking in the 1st or 2nd trimester. Many do this only for pregnancy and the risk of postpartum relapse is high (up to 82 % at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. No drug treatment can be recommended to prevent the smoking postpartum relapse. Only global counseling can prevent this risk.
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Affiliation(s)
- E Perdriolle-Galet
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France.
| | - V Peyronnet
- Service de gynécologie-obstétrique, université de Paris, hôpital Louis Mourier, 92700 Colombes, France
| | - C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
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Stroud LR, Bublitz MH, Crespo FA, Lester B, Salisbury AL. Maternal smoking in pregnancy, fetal activity & newborn behavioral state: An observational ultrasound study. Neurotoxicol Teratol 2020; 81:106894. [PMID: 32407872 DOI: 10.1016/j.ntt.2020.106894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022]
Abstract
Maternal smoking during pregnancy (MSDP) remains one of the most common prenatal drug exposures in the US and worldwide. MSDP is associated with medical risk for the fetus and altered behavioral development in infants; however, fewer studies have examined the impact of MSDP on fetal behavior or newborn behavioral state. We investigated associations between MSDP and (a) fetal motor activity and (b) newborn behavioral state following handling. Participants were 79 healthy mother-fetus/newborn pairs (57% MSDP-exposed). MSDP was measured by maternal interview and verified by saliva biomarkers. Mothers completed an observational fetal ultrasound assessment between 24 and 37 weeks gestation (M = 28 weeks), including baseline, vibro-acoustic stimulus and recovery periods. Total fetal motor activity and complex body movements were coded from ultrasound videos. Following delivery, newborn post-handling behavioral state was assessed by direct observational coding. MSDP exposure was associated with higher baseline fetal motor activity, particularly at younger gestational ages. Further, motor reactivity to stimulation emerged at later gestational ages in MSDP-exposed fetuses, while motor reactivity was consistent across gestational ages in unexposed fetuses. Finally, heavy MSDP exposure was associated with more arousal following handling and greater need for soothing interventions in the newborn period. Monitoring of fetal behavior via ultrasound may offer a unique opportunity to identify at-risk infants and provides data for stronger public health messaging regarding risks of MSDP. Associations between MSDP and increased newborn fussiness highlight opportunities for education and anticipatory guidance in the postpartum period.
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Affiliation(s)
- Laura R Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.
| | - Margaret H Bublitz
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Women's Medicine Collaborative, The Miriam Hospital, Providence, RI, USA.
| | - Frank A Crespo
- Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA.
| | - Barry Lester
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Amy L Salisbury
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Brown Center for the Study of Children at Risk, Women and Infants Hospital of Rhode Island, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, USA.
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Aljandaleh H, Bolze C, El-Khoury Lesueur F, Melchior M, Mary-Krause M. Factors Associated with Electronic Cigarette Use among Young Adults: The French "Trajectoires EpidéMiologiques en POpulation" (TEMPO) Cohort Study. Subst Use Misuse 2020; 55:964-972. [PMID: 31997695 DOI: 10.1080/10826084.2020.1717534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Electronic cigarettes (e-cigarettes) are sold in France since 2010 and have rapidly become popular. However, factors associated with e-cigarette use among young adults are not well known. Methods: We used data from the 2015 French TEMPO community based cohort study, restricted to current and former smokers with data on e-cigarette use (n = 368 adults, 23-41 years). Participants completed a self-administered questionnaire including information on family status, educational attainment, occupation and type of work contract, health problems, alcohol and cannabis use, electronic cigarette use, as well as perceptions of e-cigarettes. Use of traditional tobacco was assessed in 2011 and 2015. Data were analyzed using logistic regression models. Results: Among current and former smokers, 26.9% reported lifetime e-cigarettes use and 15.2% current use. Factors associated with lifetime use were: low socioeconomic position (OR = 2.2; 95% CI = 1.2-4.2), traditional cigarette use (OR associated with smoking in 2011 and 2015 = 13.1; 95% CI = 5.2-32.6) and positive perceptions of e-cigarettes (OR = 4.4; 95% CI = 2.4-8.1) as well as asthma (OR = 2.1; 95% CI = 0.9-4.9) and overweight/obesity (OR = 2.5, 95% CI = 0.9-6.9). Factors associated with current use were traditional cigarette smoking (OR associated with smoking in 2011 and 2015 = 3.9; 95% CI= 1.3-12.2) and positive perceptions of e-cigarettes (OR =4.4; 95% CI = 2.3-8.4). Conclusions: Young adults who use e-cigarettes tend to persist in smoking traditional cigarettes. The conditions under which e-cigarette use can help individuals quit traditional tobacco products remain to be elucidated.
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Affiliation(s)
- Hala Aljandaleh
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France
| | - Camille Bolze
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France
| | - Fabienne El-Khoury Lesueur
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France
| | - Murielle Mary-Krause
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France
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Testa A, Jackson DB, Vaughn MG, Bello JK. Incarceration as a unique social stressor during pregnancy: Implications for maternal and newborn health. Soc Sci Med 2019; 246:112777. [PMID: 31918349 DOI: 10.1016/j.socscimed.2019.112777] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/12/2019] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Abstract
RATIONALE Exposure to incarceration during pregnancy is a stressful life event that poses risk for both maternal and newborn health. OBJECTIVE We conducted a pooled, cross-sectional analysis of the link between incarceration exposure of mothers during pregnancy - personally or vicariously through a romantic partner - and maternal and newborn health using data from the Pregnancy Risk Assessment Monitoring System from years 2012-2015. METHOD We applied a novel approach that compares mothers who were exposed to incarceration to the strategic comparison group of mothers who were not exposed to incarceration, but experienced varying numbers of stressors. RESULTS The initial findings indicated that respondents exposed to incarceration exhibited reductions in maternal and newborn health relative to respondents not exposed to incarceration. However, these differences were substantially attenuated when comparing the incarceration-exposed group to a more comparable stressor-exposed reference group. CONCLUSIONS While incarceration exposure has adverse consequences for health outcomes of mothers and newborns, incarceration exposure may not carry unique implications for maternal and newborn wellbeing beyond the clustering of other stressful life events. Policies targeting incarceration exposure as a means of promoting health must also provide adequate attention to co-occurring stressors.
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Affiliation(s)
- Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA.
| | - Dylan B Jackson
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA
| | - Michael G Vaughn
- School of Social Work, Saint Louis University, Saint Louis, MO, USA; Graduate School of Social Welfare, Yonsei University, Seoul, South Korea
| | - Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
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Patten CA, Koller KR, Flanagan CA, Hiratsuka V, Merritt ZT, Sapp F, Meade CD, Hughes CA, Decker PA, Murphy N, Thomas TK. Postpartum Tobacco Use and Perceived Stress among Alaska Native Women: MAW Phase 4 Study. Int J Environ Res Public Health 2019; 16:E3024. [PMID: 31438550 PMCID: PMC6747207 DOI: 10.3390/ijerph16173024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 01/29/2023]
Abstract
Prior research explored reasons for tobacco use among pregnant Alaska Native (AN) women but did not address the postpartum period. This study followed up with AN women one to three years postpartum who had participated in a prenatal smoking cessation intervention study (Motivate Alaska Women (MAW) Phase 3) and had consented to be re-contacted for future studies. Of 47 eligible women, 32 (68%) participated. A semi-structured phone interview was conducted a mean of 2.0 years after delivery (range 1.6-2.8). Measures assessed self-reported tobacco use status in the 12 months after delivery, at 12 months postpartum, and at the time of the interview; reasons for maintaining abstinence, continued use, or relapse; and included the Perceived Stress Scale (PSS) and Negative Affect (NA) scale. Content analysis was used to generate themes from open-ended response items. Tobacco use was reported by 23 women (72%) at delivery, 30 (94%) within the 12 months after delivery, 27 (84%) at 12 months postpartum, and 29 (91%) at the time of the interview. Among nine women not using tobacco at delivery, seven (78%) relapsed during the 12 months after delivery. Of the 29 current tobacco users, 28 (97%) smoked cigarettes. Twenty-seven participants (84%) reported stress and 15 (52%) indicated addiction as reasons for continuing, starting, or resuming tobacco use. Types of stressors were related to parenting and traumatic experiences. Among current tobacco users, mean NA score (18.7) was significantly higher (p = 0.01) than the normative mean (14.8), but no differences were detected for PSS score. In this sample of AN women, postpartum tobacco use was highly prevalent, and stress was a primary reason that women endorsed for using tobacco. These preliminary results have several practice and research implications for exploring ways to support non-tobacco use among postpartum AN women.
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Affiliation(s)
- Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Kathryn R Koller
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Christie A Flanagan
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Vanessa Hiratsuka
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK 99508, USA
| | - Zoe T Merritt
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Flora Sapp
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Crystal D Meade
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
| | - Christine A Hughes
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Neil Murphy
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK 99508, USA
| | - Timothy K Thomas
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK 99508, USA
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