Factors Associated With Postpartum Smoking Relapse Among Women Who Quit in Early Pregnancy: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study.

Taku Obara,Shinichi Kuriyama,Mami Ishikuro,Aoi Noda,Keiko Murakami,Fumihiko Ueno,Tomomi Onuma

doi:10.2188/jea.je20200609

Abstract

While a wide range of predictors of postpartum smoking relapse have been suggested, population-based studies have rarely examined these factors exclusively among women who quit in early pregnancy. Furthermore, workplace secondhand smoke (SHS) exposure has never been examined. We analyzed data from 10,466 pregnant women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Age, education, parity, breastfeeding, postpartum depression, SHS exposure at home, and SHS exposure at work (not working, working without SHS exposure, working with SHS exposure) were evaluated as possible predictors. Multiple logistic regression analyses were conducted to examine the associations between these factors and smoking relapse by 1 year postpartum among women who quit in early pregnancy. Analyses stratified by SHS exposure at home were also conducted. About one-fourth of early-pregnancy quitters had relapsed into smoking by 1 year postpartum. Lower education, multiparity, not breastfeeding, postpartum depression, and SHS exposure at home were associated with increased risks of smoking relapse. Working with SHS exposure was associated with an increased risk of smoking relapse; the multivariate-adjusted odds ratios of working without SHS exposure and working with SHS exposure compared with not working were 1.14 (95% confidence interval [CI], 0.82-1.59) and 2.18 (95% CI, 1.37-3.46), respectively. The significant association of workplace SHS exposure was observed only among women without SHS exposure at home. SHS exposure at work, as well as education, multiparity, breastfeeding, postpartum depression, and SHS exposure at home were associated with postpartum smoking relapse among early-pregnancy quitters.

Highlights

Despite decreases in smoking prevalence rates during pregnancy, the relapse rates within the first year postpartum remain high in high-income countries.[1,2] Postpartum smoking increases women’s health risks[3] and exposes infants to secondhand smoke (SHS), which has been linked to sudden infant death syndrome, ear infections, respiratory tract illness, and asthma, as well as deficits in cognitive performance.[4]
Until recently, smoking in workplaces was not prohibited by law in Japan at the national level. Considering these circumstances, we aimed to prospectively examine the associations of SHS exposure at work as well as age, education, parity, breastfeeding, postpartum depression, and SHS exposure at home with postpartum smoking relapse among women who quit in early pregnancy in Japan
Of the remaining 21,906 women, 11,481 women were excluded: 520 who did not complete the questionnaires in early pregnancy (

Summary

Introduction

Despite decreases in smoking prevalence rates during pregnancy, the relapse rates within the first year postpartum remain high in high-income countries.[1,2] Postpartum smoking increases women’s health risks[3] and exposes infants to secondhand smoke (SHS), which has been linked to sudden infant death syndrome, ear infections, respiratory tract illness, and asthma, as well as deficits in cognitive performance.[4]. One systematic review concluded that the most common significant factors were being less well educated; young age; multiparity; living with a partner or household member who smoked; experiencing high stress, depression, or anxiety; not breastfeeding; intending to quit during pregnancy only; and low confidence to remain abstinent postpartum.[5]. Studies examining these factors have mainly evaluated intervention-assisted quitters, postpartum retrospective reports, or reports in middle=late pregnancy.[5]. While a wide range of predictors of postpartum smoking relapse have been suggested, population-based studies have rarely examined these factors exclusively among women who quit in early pregnancy. Workplace secondhand smoke (SHS) exposure has never been examined

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