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Smoking Cessation and Relapse Among Pregnant African-American Smokers in Washington, DC

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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.

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Acknowledgments

The authors wish to thank the field work staff, the interviewers, and data management staff. We wish to thank the participants who welcomed us into their lives in hopes of helping themselves and their children. This work was supported by grants no. 3U18HD030445; 3U18HD030447; 5U18HD31206; 3U18HD031919; 5U18HD036104, Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services. These analyses were supported, in part, by the intramural program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Conflict of interest

None of the authors have any conflict of interests to declare.

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Authors and Affiliations

  1. College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA

    Ayman A. E. El-Mohandes

  2. RTI International (RTI International is a trade name of Research Triangle Institute), Rockville, MD, USA

    M. Nabil El-Khorazaty & Marie G. Gantz

  3. National Institutes of Health, Bethesda, MD, USA

    Michele Kiely

  4. Epidemiology Branch, Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd, Rm. 7B-05, Rockville, MD, 20852-7510, USA

    Michele Kiely

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  1. Ayman A. E. El-Mohandes
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  2. M. Nabil El-Khorazaty
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  3. Michele Kiely
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  4. Marie G. Gantz
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Correspondence to Michele Kiely.

Additional information

M. Nabil El-Khorazaty: Deceased.

Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00381823.

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El-Mohandes, A.A.E., El-Khorazaty, M.N., Kiely, M. et al. Smoking Cessation and Relapse Among Pregnant African-American Smokers in Washington, DC. Matern Child Health J 15 (Suppl 1), 96–105 (2011). https://doi.org/10.1007/s10995-011-0825-6

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