Discussion and Implications
The goal of this study was to identify significant predictors of postpartum relapse to smoking using an available dataset from residents of Pennsylvania . Smoking three months before pregnancy and abstinence during the entire pregnancy ( zero cigarettes smoked during pregnancy ) was required to be selected for analysis . Our study concluded there was a 45 % relapse rate for 2011 . Other researchers may identify potential relapse candidates as women reporting any smoking during the last three months before pregnancy and no smoking during the last three months of pregnancy . Using this definition , postpartum relapse rates for Pennsylvania covering 2007 through 2011 were calculated at 59.6 %, 51.2 %, 47.7 %, 50.2 %, and 41.8 %, respectively ( Rockhill et al ., 2016 ). For women in Pennsylvania , postpartum relapse rates have shown an encouraging downward trend over this five-year time period .
Contrary to results from research in the literature , our study of 145 women found only a connection between breastfeeding status and postpartum smoking status . Initiation of breastfeeding and length of breastfeeding have repeatedly been connected with maintained smoking abstinence in the postpartum period ( Colman & Joyce , 2003 ; Martin et al ., 2008 ). For the current study , women who never initiated breastfeeding were over three times more likely to return to tobacco use in the postpartum period than women who were still breastfeeding when they completed the survey . An unusual
Issue 2 2017 Pennsylvania Nurse 8 finding from this study involved women who breastfed between 7-26 weeks . These women were six times more likely to return to smoking than women who were still breastfeeding when they completed the survey . Since women answer the questions independently , perhaps some confusion existed about the questions and responses within the PRAMS survey inquiring about breastfeeding status leading to this contradictory result . This unexpected finding warrants further study .
The PRAMS dataset is a reliable and standardized source of information covering women ’ s tobacco use before , during , and after pregnancy . The questions are delivered in a nonjudgemental manner and answered directly and anonymously by the women themselves . A majority of states participate in the monitoring system and a process exists to request single-state or multi-state datasets . Targeted analyses of these annual datasets have the potential to identify geographic differences and changes in patterns over time as well as insight into this complex phenomenon of postpartum abstinence versus relapse to smoking .
This project was an exploration of possible predictors of relapse for 145 women . Because of the relatively small sample size , the study may not have been powered to detect additional factors associated with smoking relapse . Larger samples are required to identify consistent predictors of postpartum relapse to smoking . A primary goal of prenatal care is maternal education regarding important aspects of health to promote better maternal and newborn outcomes . An awareness of the multitude of potential variables associated with a return to smoking will assist maternalchild healthcare providers to explore which factors may have particular relevance to individual women in order to personalize relapse prevention activities . Ongoing analysis of the PRAMS data may assist in our understanding of this complex phenomenon .
Acknowledgements
1 . Pennsylvania Department of Health , Bureau of Health Statistics and Research
2 . James Rubertone , Descriptive Statistician , Pennsylvania Department of Health 3 . Tony Norwood , Pennsylvania PRAMS Coordinator , Pennsylvania Department of Health
4 . This research was supported by Technology : Research on Chronic and Critical Illness ( 2T32 NR008857 ) and Department of Education Graduate Assistance in Areas of National Need ( P200A12097 ).
References
Colman , G . J ., & Joyce , T . ( 2003 ). Trends in smoking before , during , and after pregnancy in ten states . American Journal of Preventive Medicine , 24 ( 1 ), 29-35 .
Constantine , N . A ., Slater , J . K ., Carroll , J . A ., & Antin , T . M . ( 2014 ). Smoking cessation , maintenance , and relapse experiences among pregnant and postpartum adolescents : A qualitative analysis . Journal of Adolescent Health . doi : 10.1016 / j . jadohealth . 2013.12.027
Flemming , K ., Graham , H ., Heirs , M ., Fox , D ., & Sowden , A . ( 2013 ). Smoking in pregnancy : A systematic review of qualitative research of women who commence pregnancy as smokers . Journal of Advanced Nursing , 69 ( 5 ), 1023- 1036 . doi : 10.1111 / jan . 12066
Jones , M ., Lewis , S ., Parrott , S ., Wormall , S ., & Coleman , T . ( 2016 ). Re-starting smoking in the postpartum period after receiving a