title: Weight concerns, mood, and postpartum smoking relapse.
abstract: BACKGROUND
  The majority of women who quit smoking as a result of pregnancy will resume smoking during the first 6 months postpartum. Evidence suggests that changes in depressive symptoms, perceived stress, and concerns about weight may relate to postpartum smoking relapse.
  
  
  OBJECTIVE
  This study was designed to prospectively evaluate the relationship of mood and weight concerns to postpartum smoking among women who quit smoking during pregnancy.
  
  
  METHODS
  Pregnant women who had quit smoking (N=183) were recruited between February 2003 and November 2006. Women completed assessments of mood (depressive symptoms, perceived stress, positive and negative affect) and weight concerns during the third trimester of pregnancy and at 6, 12, and 24 weeks postpartum. Self-reported smoking status was verified by expired-air carbon monoxide and salivary cotinine at each assessment. Cox regression analyses in which mood and weight concerns were treated as time-dependent covariates were conducted in 2007 and 2009.
  
  
  RESULTS
  By 24 weeks postpartum, 65% of women had resumed smoking. Smoking-related weight concerns increased risk of relapse, and positive affect and self-efficacy for weight management without smoking decreased risk of relapse postpartum. Moreover, after controlling for variables previously related to postpartum relapse, weight concerns remained significantly related to smoking relapse.
  
  
  CONCLUSIONS
  Smoking-related weight concerns and positive affect increase the likelihood that a woman will resume smoking postpartum. Moreover, weight concerns appear to be salient even in the context of other factors shown to affect postpartum smoking. This study suggests that interventions may need to address women's weight concerns and mood to help sustain smoking abstinence after childbirth.
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Levinem@upmc.edu
authors.forename: Michele D
authors.initials: MD
authors.lastname: Levine
authors.forename: Marsha D
authors.initials: MD
authors.lastname: Marcus
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Kalarchian
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: Yu
authors.initials: Y
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D001828:Body Image; D001835:Body Weight; D019052:Depression, Postpartum / Q000523:psychology; D005260:Female; D006801:Humans; D009035:Mothers / Q000523:psychology; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology; D055815:Young Adult