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Innovation to prevent post-partum relapse

Institution: University of California, San Francisco
Investigator(s): Jennifer Haas, M.D.
Award Cycle: 2000 (Cycle 9) Grant #: 9IT-0192 Award: $75,000
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Inno Dev & Exp Awards (IDEAS)

Initial Award Abstract
5. Cigarette smoking is the leading cause of preventable morbidity and mortality for women in the United States. Pregnancy is a pivotal event of young adulthood for many women. This is confirmed by the observation that women are much more likely to quit smoking around the time of pregnancy than at any other. Unfortunately, women who quit during pregnancy have extremely high rates of relapse during the months immediately following delivery. There are several reasons why post-partum women are at high risk of relapse including: decreased motivation, depression, stress, sleep deprivation, and concerns about the loss of weight gained during pregnancy. Conversely, there are many reasons to think that the perinatal period is an important opportunity to influence a woman’s lifetime smoking behavior including: parenthood and a growing sense of responsibility, more frequent contact with the health care system, and less severe nicotine cravings because a woman has already been smoke-free for several months.

Behavioral intervention during pregnancy has not been associated with an increase in post-partum tobacco abstinence. Recent studies suggest that bupropion is effective therapy for smoking cessation. There are several reasons that bupropion may be an effective therapy to prevent relapse post-partum, including mood stabilization, decreased fatigue, decreased tobacco craving, and increased weight loss. To date, there is no literature examining the use of bupropion or other anti-depressants as part of an intervention to prevent post-partum relapse. In the proposed IDEA Award program, we will conduct a series of exploratory studies to examine the feasibility of incorporating bupropion into an innovative treatment program to prevent post-partum smoking relapse. The results of this work will be used to design a randomized controlled clinical trial to prevent post-partum smoking relapse that will incorporate pharmacotherapy in addition to a behavioral intervention.

The proposed project will address the following Specific Aims: (1) To define an appropriate target population for a pharmacologic intervention to prevent post-partum relapse to tobacco use, we will quantify the amount of bupropion in breastmilk of 20 women who are lactating but not breastfeeding. The results of this Aim will determine whether it is safe to administer bupropion to post-partum women who are still breastfeeding or contemplating breastfeeding or whether it is necessary to wait until a woman is no longer breastfeeding. (2) To inventory, categorize and evaluate behavioral smoking cessation and relapse prevention interventions for pregnant and post-partum women. (3) To obtain explicit information about how best to target a multi-faceted intervention to prevent post-partum smoking relapse, we will conduct interviews with a multi-ethnic sample of 50 women. Each woman will be surveyed twice: once during pregnancy and the then again 6 – 8 weeks postpartum. These surveys will examine: (a) The prevalence and duration of breastfeeding among a multi-ethnic sample of women who have quit smoking during pregnancy. (b) A woman’s perception of her risk of relapse. (c) The acceptability of a pharmacologic intervention during the post-partum period. (d) The acceptability of a variety of behavioral interventions (e.g., content, format, intensity) for these women and their household members.

Pregnancy is an important opportunity in young adulthood to reduce a woman’s lifetime exposure to tobacco. If women can be converted from pregnancy-quitters to long-term quitters this would significantly reduce their lifetime exposure to tobacco as well as reducing the exposure of their children to environmental tobacco smoke. The results of the proposed research will lead directly to an innovative, multi-faceted, targeted intervention to prevent post-partum relapse in a multi-ethnic cohort of women.