Three-quarters of women who quit smoking during pregnancy return to smoking by one year after pregnancy. Interventions to help women avoid smoking after pregnancy have been unsuccessful. This dissertation presents a body of work aimed at understanding better the phenomenon of smoking after pregnancy with the goal of informing interventions more effective at helping women transition from being pregnant former smokers to permanent former smokers.
This document presents four research studies. The first two studies are secondary analyses of data and focus on the relationship between breastfeeding and smoking, since prior studies have shown these behaviors to be inversely related. Main findings from these two studies are: 1) The patterns of and relationship between breastfeeding and smoking are different for low-income mothers than for mothers in general. In one-time face-to-face interviews of low-income, predominantly African-American mothers of infants under 8 months old, active breastfeeding was not associated with smoking after pregnancy. Furthermore, although prior studies have shown that African-American mothers are more likely to smoke after pregnancy compared to white mothers, this analysis presented here indicates that low-income African-American mothers are less likely to smoke cigarettes after pregnancy than low-income white mothers. 2) A population-based intervention to promote breastfeeding is not sufficient to reduce smoking in the first year after pregnancy. In a longitudinal study of 16,889 mothers enrolled in the largest randomized controlled trial of promotion of breastfeeding, mothers who received the intervention, which successfully increased duration of breastfeeding, were equally likely to smoke cigarettes after pregnancy compared to women in the control group.
Taken together, these secondary analyses indicate that breastfeeding does not cause decreased smoking after pregnancy. There are likely other factors which explain why women who breastfeed may be less likely to smoke and vice versa. To explore these factors further, I then conducted two primary studies to identify and quantify targets for intervention. The theoretical framework used for these studies was the Theory of Planned Behavior (TPB). Main findings from these two studies are: 1) Most women who quit smoking during pregnancy did not intend to resume smoking, but fulfillment of this intention may be impeded by contradictory beliefs about smoking after pregnancy which they expressed during face-to-face interviews. 2) The Smoking After Pregnancy Heuristics and Intention Research (SAPHIRE) Questionnaire is valid as a TPB-based questionnaire. That is, it is acceptable to the target population, feasible, and internally consistent. The SAPHIRE was developed from themes discovered in the face-to-face interviews and designed to predict smoking after pregnancy. If on-going study shows that the SAPHIRE is a good predictor of smoking after pregnancy, the beliefs quantified in the SAPHIRE will provide a roadmap for interventions that may be more effective in helping women avoid smoking after pregnancy. 3) Women who quit smoking during pregnancy report high levels of stress that are not associated with intention to return smoking after pregnancy. Distrust of the healthcare system and the fact that most pregnancies were unintended are barriers that must be addressed to improve interventions to help women avoid smoking after pregnancy.
|Advisor:||Mayes, Linda C.|
|School Location:||United States -- Connecticut|
|Source:||DAI-B 72/10, Dissertation Abstracts International|
|Subjects:||Medicine, Behavioral psychology, Womens studies, Public health, Epidemiology|
|Keywords:||Breast feeding, Planned behavior, Postpartum tobacco use, Pregnancy, Relapse prevention, Smoking|
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