The majority of women who quit smoking during pregnancy will relapse during the first year postpartum, and postpartum smoking has deleterious effects on the health of both the mother and her children. For example, smoking increases the risk of certain cancers, respiratory symptoms and reproductive complications among women, and exposure to tobacco smoke has been linked to sudden infant death syndrome, ear infections, respiratory illness and asthma among children. Previous interventions designed to address postpartum smoking have not successfully increased rates of sustained abstinence postpartum. However, our research has documented that mood and weight concerns are associated with postpartum smoking relapse, and pilot data support the acceptability of strategies to address mood and weight concerns in the postpartum period. Thus, this application proposes a randomized controlled trial of a novel, cognitive behavioral postpartum relapse prevention program that addresses women's mood and weight concerns delivered during the postpartum period when the risk of relapse is high. Pregnant women who have quit smoking and are interested in saying quit postpartum (N = 300) will be randomly assigned to: 1) a relapse prevention intervention that addresses mood and weight concerns, or 2) a nondirective, supportive condition designed to control for the effects of therapeutic time and attention. We hypothesize that relapse will be less likely at 6 and 12 months postpartum for women in the intervention group than those in the supportive condition. We will also examine the mediators and moderators of treatment response. Results of this investigation will provide information on the efficacy of a cognitive behavioral relapse prevention intervention that incorporates strategies to address mood and weight concerns to prevent smoking relapse and inform future research on the prevention of smoking and other drug use postpartum.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Human Development Research Subcommittee (NIDA)
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Grossman, Debra
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University of Pittsburgh
Schools of Medicine
United States
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Emery, Rebecca L; Gregory, Melissa P; Grace, Jennifer L et al. (2016) Prevalence and correlates of a lifetime cannabis use disorder among pregnant former tobacco smokers. Addict Behav 54:52-8
Levine, Michele D; Cheng, Yu; Marcus, Marsha D et al. (2016) Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial. JAMA Intern Med 176:443-52
Slane, Jennifer D; Levine, Michele D (2015) Association of Restraint and Disinhibition to Gestational Weight Gain among Pregnant Former Smokers. Womens Health Issues 25:390-5
Levine, Michele D; Cheng, Yu; Marcus, Marsha D et al. (2015) Psychiatric disorders and gestational weight gain among women who quit smoking during pregnancy. J Psychosom Res 78:504-8
Creswell, Kasey G; Cheng, Yu; Levine, Michele D (2015) A test of the stress-buffering model of social support in smoking cessation: is the relationship between social support and time to relapse mediated by reduced withdrawal symptoms? Nicotine Tob Res 17:566-71
Levine, Michele D; Marcus, Marsha D; Kalarchian, Melissa A et al. (2013) Strategies to Avoid Returning to Smoking (STARTS): a randomized controlled trial of postpartum smoking relapse prevention interventions. Contemp Clin Trials 36:565-73
Levine, Michele D; Cheng, Yu; Cluss, Patricia A et al. (2013) Prenatal smoking cessation intervention and gestational weight gain. Womens Health Issues 23:e389-93
Levine, Michele D; Cheng, Yu; Marcus, Marsha D et al. (2012) Relapse to smoking and postpartum weight retention among women who quit smoking during pregnancy. Obesity (Silver Spring) 20:457-9
Levine, Michele D; Perkins, Kenneth A; Kalarchian, Melissa A et al. (2010) Bupropion and cognitive behavioral therapy for weight-concerned women smokers. Arch Intern Med 170:543-50
Levine, Michele D; Marcus, Marsha D; Kalarchian, Melissa A et al. (2010) Weight concerns, mood, and postpartum smoking relapse. Am J Prev Med 39:345-51

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