Abstract
The aim of this study was to explore the role of affect management in postpartum relapse to smoking. Between January and October 2005, 65 women who smoked prior to pregnancy but not during the last month of pregnancy were recruited from Brigham and Women’s Hospital in Boston, MA, and followed for 24 weeks. Surveys administered at baseline, 2, 6, 12, and 24 weeks postpartum assessed smoking status and symptoms of depression (Beck Depression Inventory, BDI) and anxiety (Beck Anxiety Inventory, BAI). Qualitative interviews were conducted when women relapsed or achieved an elevated BDI or BAI score. Elevated BDI or BAI scores did not predict relapse, suggesting that symptoms that make women vulnerable to relapse may not be fully captured by these instruments. Women described feelings of anger or frustration as part of the relapse experience. Women with elevated BDI or BAI scores who did not relapse were more likely to normalize their mood symptoms as part of the postpartum experience and described more adaptive and active coping strategies. Interventions designed to prevent postpartum relapse to smoking may need to target a broader range of negative affect and mood management strategies to increase the likelihood of efficacy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allen AM, Prince CB, Dietz PM (2009) Postpartum depressive symptoms and smoking relapse. Am J Prev Med 36:9–12
Bothwell S, Weissman MM (1977) Social impairments four years after an acute depressive episode. Am J Orthopsychiatry 47:231–237
Breslau N, Kilbey M, Andreski P (1991) Nicotine dependence, major depression, and anxiety in young adults. Arch Gen Psychiatry 48:1069–1074
Caudill MA (2002) Managing pain before it manages you. Guilford, New York
CDC (Centers for Disease Control and Prevention) (2008) Smoking prevalence among women of reproductive age—United States, 2006. MMWR Morb Mortal Wkly Rep 57:849–852
Curry SJ, McBride CM (1994) Relapse prevention for smoking cessation: review and evaluation of concepts and interventions. Annu Rev Public Health 15:345–366
Fang WL, Goldstein AO, Butzen AY, Hartsock SA, Hartmann KE, Helton M et al (2004) Smoking cessation in pregnancy: a review of postpartum relapse prevention strategies. J Am Board Fam Pract 17:264–275
Fingerhut LA, Kleinman JC, Kendrick JS (1990) Smoking before, during, and after pregnancy. Am J Public Health 80:541–4
Glassman AH, Covey LS (1996) Smoking and affective disorder. Am J Health Behav 20:279–285
Hall SM, Munoz RF, Reus VI, Sees KL (1993) Nicotine, negative affect, and depression. J Consult Clin Psychol 61:761–767
Hernandez-Lopez M, Luciano MC, Bricker JB, Roales-Nieto JG, Montesinos F (2009) Acceptance and commitment therapy for smoking cessation: a preliminary study of its effectiveness in comparison with cognitive behavioral therapy. Psychol Addict Behav 23:723–730
Kendler NS, Neale MC, MacLean CJ, Heath AC, Eaves LJ, Kessler RC (1993) Smoking and major depression: a causal analysis. Arch Gen Psychiatry 50:36–43
Letourneau AR, Sonja B, Mazure CM, O’Malley SS, James D, Colson ER (2007) Timing and predictors of postpartum return to smoking in a group of inner-city women: an exploratory pilot study. Birth 34:245–52
Levine MD, Marcus MD, Kalarchian MA, Houck PR, Cheng Y (2010) Weight concerns, mood, and postpartum smoking relapse. Am J Prev Med 39:345–351
Linehan MM (1993) Cognitive behavioral treatment of borderline personality disorder. Guilford, New York
MacPherson L, Stipelman BA, Duplinsky M, Brown RA, Lejuez CW (2008) Distress tolerance and pre-smoking treatment attrition: examination of moderating relationships. Addict Behav 33:1385–1393
Mann R, Gilbody S, Adamson J (2010) Prevalence and incidence of postnatal depression: what can systematic reviews tell us? Arch Womens Ment Health 13:295–305
McBride CM, Pirie PL (1990) Postpartum smoking relapse. Addict Behav 15:165–168
Miles M, Huberman A (1984) Qualitative data analysis: a sourcebook of new methods. Sage, Beverly Hills, CA
Nezu AM, Nezu CM, Friedman SH, Faddis S, Houts PS (1998) Helping cancer patients cope: a problem-solving approach. American Psychological Association, Washington, DC
Park ER, Chang Y, Quinn V, Regan S, Cohen L, Viguera A et al (2009) The association of depressive, anxiety, and stress symptoms and postpartum relapse to smoking: a longitudinal study. Nicotine Tob Res 11:707–714
Reitzel LR, Vidrine JI, Businelle MS, Kendzor DE, Costello TJ, Li Y et al (2010) Preventing postpartum smoking relapse among diverse low-income women: a randomized clinical trial. Nicotine Tob Res 12:326–335
Safren SA, Otto MW, Worth JL (1999) Life-steps: applying cognitive behavioral therapy to HIV medication adherence. Cogn Behav Neurol 6:332–341
Solomon LJ, Higgins ST, Heil SH, Badger GJ, Thomas CS, Bernstein IM (2007) Predictors of postpartum relapse to smoking. Drug Alcohol Depend 90:224–7
Stuart S, Couser G, Schilder K, O’Hara MW, Gorman LL (1998) Postpartum anxiety and depression: onset and comorbidity in a community sample. J Nerve Ment Dis 186:420–424
Tong VT, Jones JR, Dietz PM, D’Angelo D, Bombard JM (2009) Trends in smoking before, during, and after pregnancy—Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 sites, 2000–2005. MMWR Surveill Summ 58:1–29
U.S. Department of Health and Human Services (2011) Healthy People 2020 Summary of Objectives 2011. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26. Accessed 10 February 2011
Acknowledgments
This project was funded by grants from the Robert Wood Johnson Smoke Free Families Initiative and the American Cancer Society’s Mentored Research Scholar Award (MRSG-005-05-CPPB) to support Dr. Park’s work. We would like to thank the obstetric nursing staff at Brigham and Women’s Hospital for helping us access study participants. The authors also wish to thank Kristin Perry for interviewing participants and Jennifer Pandiscio and Kaile Ross for their assistance with preparing the data for this paper. The authors also wish to thank the participants of this study for sharing their postpartum experiences.
Author information
Authors and Affiliations
Corresponding author
Additional information
Dr. Psaros is currently a consultant for Bracket Global. Dr. Psaros performs third party reviews of fidelity to scoring conventions of measures of depression and anxiety completed as part of clinical trials. This is unrelated to the submitted manuscript. There are no potential financial conflicts of interest for Ms. Pajolek and Dr. Park.
Rights and permissions
About this article
Cite this article
Psaros, C., Pajolek, H. & Park, E.R. The role of negative affect management in postpartum relapse to smoking. Arch Womens Ment Health 15, 15–20 (2012). https://doi.org/10.1007/s00737-011-0250-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-011-0250-2