title: Smoking cessation and relapse among pregnant African-American smokers in Washington, DC.
abstract: Smoking is the single most preventable cause of perinatal morbidity. This study examines smoking behaviors during pregnancy in a high risk population of African Americans. The study also examines risk factors associated with smoking behaviors and cessation in response to a cognitive behavioral therapy (CBT) intervention. This study is a secondary analysis of data from a randomized controlled trial addressing multiple risks during pregnancy. Five hundred African-American Washington, DC residents who reported smoking in the 6 months preceding pregnancy were randomized to a CBT intervention. Psycho-social and behavioral data were collected. Self-reported smoking and salivary cotinine levels were measured prenatally and postpartum to assess changes in smoking behavior. Comparisons were made between active smokers and those abstaining at baseline and follow-up in pregnancy and postpartum. Sixty percent of participants reported quitting spontaneously during pregnancy. In regression models, smoking at baseline was associated with older age, <a high school education and illicit drug use. At follow-up closest to delivery, smoking was associated with lower education, smoking and cotinine level at baseline and depression. At postpartum, there was a relapse of 34%. Smokers postpartum were significantly more likely to smoke at baseline and use illicit drugs in pregnancy. Mothers in the CBT intervention were less likely to relapse. African-American women had a high spontaneous quit rate and no response to a CBT intervention during pregnancy. Postpartum mothers' resolve to maintain a quit status seems to wane despite their prolonged period of cessation. CBT reduced postpartum relapse rates.
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Ayman A E
authors.initials: AA
authors.lastname: El-Mohandes
authors.forename: M Nabil
authors.initials: MN
authors.lastname: El-Khorazaty
authors.forename: Michele
authors.initials: M
authors.lastname: Kiely
authors.forename: Marie G
authors.initials: MG
authors.lastname: Gantz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data*; D015928:Cognitive Behavioral Therapy; D003367:Cotinine / Q000032:analysis; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004219:District of Columbia; D005260:Female; D006801:Humans; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D003367:Cotinine