Chantal Lewis, Masters of Public Health Candidate 2017

ASSOCIATION BETWEEN MULTIPLE SOURCES OF STRESS AND SMOKING CESSATION DURING PREGNANCY

School of Public Health, Brown University, Providence, RI

BACKGROUND

OBJECTIVE

METHODS

RESULTS

CONCLUSIONS

ACKNOWLEDGEMENTS

REFERENCES

• To examine the association between having multiple stressorsand smoking cessation during pregnancy among Rhode Islandwomen who smoked before pregnancy.

A special thank you to Hanna Kim PhD, Karine Monterio MPH and Annie Gjelsvik, PhD, for their support and contributions.

• 2009-2013 aggregated Rhode Island Pregnancy Risk AssessmentMonitoring System (PRAMS) data was used. A total of 9,414recent mothers were sampled and 6,241 completed the survey,with an average response rate of 67.4%.

• Only women who smoked prior to pregnancy were included inthis study, yielding an analytic sample size of n=1,304.

• The exposure, prenatal stress, was defined dichotomously: 1)either having two or less of the 14 measures of stress sources or2) having three or more sources of stress. Stressors wereidentified from different sources such as financial stress,emotional stress and partner-related stress.

• The outcome, smoking cessation, was defined as women whosmoked 3 months prior to conceiving and did not smoke withinthe last 3 months (or more) of pregnancy.

• Chi-square tests and logistic regression analyses were performedto examine the association between having multiple stressors andthe likelihood of continuing to smoke during pregnancy. STATAv14.0 software was used to carry out these tests.

• Healthcare providers should encourage their smoking femalepatients to undertake behavior modification (such as stressmanagement), before attempting pregnancy.

• These programs should target various groups of women (suchas heavy smokers) using different programs.

• Of the women who smoked before pregnancy, 47.0%continued to smoke during their pregnancy.

• Of the women who smoked before pregnancy, 55% had twoor less stressors and 45% had three or more stressors duringpregnancy. (Table 1)

• Among smokers, pregnant women who experienced 3 ormore stressors had 1.72 (95% CI: 1.33, 2.24) times the oddsof continuing to smoke during pregnancy, compared to thosewho experienced 2 or less stressors. After adjusting for allfactors in table 2, the adjusted odds ratio remainedsignificant (AOR=1.38; 95% CI: 1.04, 1.84). (Table 2)

• Factors such as marital status, education, and number ofcigarettes smoked before pregnancy, were also significantlyassociated with prenatal smoking cessation. (Table 2)

• Women who smoke during their pregnancy (prenatal smoking)are more likely to experience premature rupture of membranes(PROM), placental abruption, or placenta previa1.

• Babies born to women who smoke during pregnancy are morelikely to be born prematurely, are often born with significantlylower birth weight, or even die of Sudden Unexpected InfantDeath (SUID)2.

• Stress during pregnancy, have been shown to be independentlyassociated with higher risk of continued smoking3.

1. Office of the Surgeon General (US); Office on Smoking and Health (US). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2004. 5, Reproductive Effects. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44697/

2. DiFranza J, Aligne C, Weitzman M. Prenatal and Postnatal Environmental Tobacco Smoke Exposure and Children’s Health. Pediatrics [Internet] 2004 [cited 2016 Mar 27];113(Supplement 3):1007-1015. Available from: http://pediatrics.aappublications.org/content/113/Supplement_3/1007

3. 3. Gilbert N, Nelson C, Greaves L. Smoking Cessation During Pregnancy and Relapse After Childbirth in Canada. Journal of Obstetrics and Gynaecology Canada 2015;37(1):32-39.

TABLE 1: Description of Study Population by Level of Stress during Pregnancy: PRAMS, 2009-2013

Table 2: Unadjusted and Adjusted Odds Ratios for Continuing to Smoke During Pregnancy Among Women who Smoked Prior to Pregnancy, PRAMS 2009-2013

Unadjusted OR (UOR) Adjusted OR (AOR)

Two or less stressors

Three or more stressors

1.00 ref

1.73 (1.33, 2.24)

1.00 ref

1.38 (1.04, 1.84)

Married

Not Married

1.00 ref

2.25 (1.70, 2.98)

1.00 ref

1.70 (1.21, 2.37)

<=20 Cigs before pregnancy

>20 Cigs before pregnancy

1.00 ref

3.37 (1.93, 5.89)

1.00 ref

2.99 (1.65, 5.42)

No Alcohol during pregnancy

Some Alcohol during pregnancy

1.00 ref

1.25 (0.82, 1.90)

1.00 ref

1.21 (0.78 , 1.87)

College or higher

No College

1.00 ref

2.35 (1.80, 3.07)

1.00 ref

2.08 (1.55, 2.80)

Medicaid Insurance

No Medicaid Insurance

1.00 .ref

0.56 (0.42, 0.74)

1.00 ref

0.69 (0.51, 0.95)

Maternal age <30

Maternal age >= 30

1.18 (0.91, 1.53)

1.00 ref

1.30 (0.95, 1.77)

1.00 ref

Wanted pregnancy

Did not want pregnancy

1.00 ref

1.33 (1.03, 1.73)

1.00 ref

1.01 (0.75, 1.35)

Stress During Pregnancy

Two or less

n* (%)**

714 (55 %)

Three or more

n* (%)**

584 (45%)P-value

Have you quit smoking during pregnancy?

Stopped during pregnancy

Continued

426 (64%)

228 (36%)

261(50%)

323 (50%)

<0.0001

Pregnancy Intention

Wanted

Did Not Want

410 (57%)

292(43%)

215(35%)

355(65%)

<0.0001

Number of Cigarettes Before Pregnant

<=20

>20

680 (96%)

34 (4%)

531 (90%)

53 (10%)

0.0005

Marital Status

Married

Not Married

311 (41%)

403 (59%)

139 (24%)

445 (76%)

<0.0001

Alcohol Consumption During Pregnant

Yes

No

58 (8.4%)

656 (91.6%)

71 (12.5%)

510 (87.5)

0.0390

Alcohol Consumption Before Pregnancy

Yes

No

529 (76.8%)

184 (23.2%)

425 (75.8%)

154 (24.2%)

0.7521

First Pregnancy

Yes

No

338 (46%)

376 (54%)

256 (47%)

328 (53%)

0.8926

Medicaid Insurance

Yes

No

173 (25%)

533 (75%)

186 (31%)

385 (69%)

0.0274

Maternal Age

<30

>=30

417 (62%)

297 (38%)

383(70%)

201(30%)

0.0067

Maternal Race

White

Non-White

421 (81%)

116(19%)

335 (77%)

107 (23%)

0.1558

Maternal Education Level

College or higher

No College

334 (46%)

380 (54%)

211 (34%)

373 (66%)

0.0003

* Unweighted number of respondents. ** Weighted percentage.