The primary goals of this project are to develop, refine, and pilot test an integrative smoking relapse prevention intervention for postpartum women. Rates of postpartum smoking relapse are high (70-90%) among women who quit smoking in anticipation of or during pregnancy, despite the fact that relapse is unintentional for a substantial number of these women. In addition to well-established health consequences for smokers, maternal smoking poses health risks for infants, including respiratory and gastrointestinal problems. Standard relapse prevention interventions are not effective for postpartum women. Sleep loss, prevalent for the first 3 months postpartum, may contribute to this problem. Sleep deprivation is known to diminish stress management skills and behavioral coping and may impact relapse prevention among new mothers through these and other mechanisms. The integrative behavioral intervention we propose, Rest Assured, is a combined relapse prevention and behavioral sleep intervention, expanding upon traditional relapse prevention strategies by improving sleep and daytime functioning for new mothers seeking to remain abstinent from cigarette smoking. We plan to utilize a home-based postpartum intervention with recently demonstrated effectiveness for the relapse prevention component and to develop the behavioral sleep component using behavioral strategies that have shown efficacy with new mothers, including more nighttime sleep for both mothers and infants.
The specific aims of this project are 1) To develop an individual 4-session combined relapse prevention and behavioral sleep intervention with an open series of patients (n = 6) and 2) To perform a small (n = 40) randomized pilot trial comparing the integrative intervention to an active control (i.e., the relapse prevention component alone).
Specific Aim 1 will be achieved using the outlined treatment manual with 3 phases (each n = 2) of cases in which smoking, sleep, and daytime functioning will be assessed pre and post. The treatment will be revised after each phase based on clinical judgment regarding issues such as content, duration, and timing.
Specific Aim 2 will be achieved with an experiment in which 40 participants will be randomly assigned either to the combined intervention condition or to the active control condition. The long-term objective of this research is to foster postpartum relapse prevention for women with a history of smoking, which, in turn, would improve the overall health of postpartum women and their families. Relevance: Maternal smoking has substantial negative health consequences for mothers and their children. Although many women quit smoking during pregnancy, most relapse postpartum. Accepted relapse prevention interventions are not effective for postpartum women because they do not address unique risk factors, such as chronic sleep loss and corresponding daytime impairment. The proposed study would constitute essential groundwork in a progressive program of research on treating postpartum sleep in women with a history of smoking to improve relapse prevention.
The negative effects of chronic sleep loss, such as weakened abilities to regulate emotion and cope with stressors, may contribute to the high rate (70-90%) of returning to smoking after giving birth. This research develops and tests a postpartum smoking relapse prevention that integrates a behavioral sleep intervention. For women who do not wish to return to smoking after giving birth, better sleep and corresponding daytime functioning could provide a critical buffer against relapse, which has substantial positive health implications for mothers and their children.