Effect of Depression and Psychosocial Stressors on Cessation Self-Efficacy in Mothers who Smoke

Abstract

Motherhood offers factors that may contribute to or confound attempts to quit smoking, including social cues around pregnancy, post partum depression, financial and other pressures of child rearing, being a role model and concern that secondhand smoke might affect their child's health. We sought to characterize a population of tobacco-using mothers in order to identify barriers to quitting that both mirror the general population and are unique to motherhood. A cross-sectional survey collected information in two urban emergency departments from women who smoked and were mothers of small children. The survey asked about tobacco use, including levels of addiction, attempts to quit, readiness and self efficacy for quitting, and other psychosocial risks. We hypothesized that mothers reporting psychosocial stressors and depression would be less motivated to quit and less likely to have attempted quitting. One hundred ninety-two smoking mothers enrolled, representing 433 children exposed to secondhand smoke. Nicotine addiction was moderate. Women reporting at least one form of stress (relationship, financial, work, emotional, family-related) had similar levels of addiction (Fagerstrom score 2.8 vs. 2.9, p=0.63) and motivation to quit (Ladder of Contemplation 6.4 vs. 6.1, p=0.26), but reported feeling less confident in their ability to quit than non-stressed counterparts (6.6 vs. 7.6, p=0.04). Over half (51.3%) of smoking mothers reported symptoms of depression for more than 2 weeks in a row in the last year. Depressed mothers had similar levels of addiction (Fagerstrom score 2.9 vs. 2.8, p=0.63), and readiness to quit (6.6 vs. 6.5, p=0.89), and had attempted to quit at similar rates (78% vs. 82%, p=0.58). However, depressed mothers were less confident in their ability to quit (6.4 vs. 7.4, p=0.02) and were more than twice as likely to report they are "not at all confident" (22% vs. 9%, p=0.03). Providers who encourage mothers to quit smoking must identify and be prepared to address psychosocial stressors and co-morbid depression.