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Mental Health and Smoking During and After Pregnancy
Ann Peden, D.S.N.,
Principal Investigator;
Ellen Hahn, D.N.S.,
Lynne Hall, Dr.P.H.,
Carol Riker, M.S.N.,
& Kristin Ashford, M.S.N.,
Co-investigators
Funded by the
University of Kentucky Faculty Research Support Program
(2004-2005)
Abstract
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The long-term objective of this research is to decrease the
prevalence of smoking during pregnancy and reduce relapse
rates during the postpartum period. Despite increased public
awareness of the many dangers of smoking during pregnancy,
Kentucky has the second highest rate in the U.S. (23%;
Kentucky Cabinet for Health Services, 2003). Cigarette
smoking in pregnancy has many maternal and fetal risks
including an increased number of miscarriages, low-birth
weight infants, preterm deliveries, still births, and
neonatal deaths. Only one third of pregnant women who stop
smoking during pregnancy remain smoke free one year after
delivery (CDC, 2001). While some research indicates that
there are interrelationships among smoking, stress, and
depression in pregnant women, research that explores these
associations is limited. Zhu and Valbo (2002) found that
depression was a significant predictor of smoking during
pregnancy and that women who were depressed were less
confident about quitting than nondepressed women. Depressed
smokers have also been found to relapse earlier than
non-depressed smokers (Kinnunen, Doherty, Militello &
Garvey, 1998). While there has been a vast amount of
research focusing on the risks to the unborn child, there
has been much less attention to the maternal factors that
influence smoking during pregnancy or the efficacy of
cessation interventions offered during pregnancy.
The specific aim of this pilot study is to test the
effects of a cognitive-behavioral group and telephone
intervention during pregnancy and the postpartum period on
women’s smoking and quit rates, secondhand smoke exposure,
and mental health. A two-group nonequivalent control group
pre-test and post-test design with repeated measures will be
used. Twenty current or former pregnant smokers will be
recruited. Data will be collected on smoking history, second
hand smoke exposure, negative thoughts (Crandall Cognitions
Inventory, Crandall & Chambliss, 1986), self-esteem
(Rosenberg Self-Esteem Inventory, Rosenberg, 1965), and
depressive symptoms (Beck Depression Inventory, Beck et al.,
1961 and Center for Epidemiologic Studies--Depression Scale,
Radloff, 1977). Participants will also be asked to provide a
urine sample to test for cotinine, a metabolite of nicotine,
at all time points. In-home air quality also will be
assessed. The intervention will consist of four 90-minute
cognitive-behavioral group sessions focused on negative
thought stopping and six postpartum phone sessions. Data
will be collected at four points in time: baseline, 1 month
post-intervention, and at 2 months and 6 months
post-delivery. Results of this study will provide vital
information about the efficacy of a cognitive-behavioral
intervention in women who smoke during pregnancy. This
information is essential for the development of a proposal
for a larger trial which will be submitted to NIH in June
2004.
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