Real Primary Prevention - Smoking Causes Disease, But What Causes Smoking?

Am J Prev Med Volume 36, Issue 1, Pages 9-12 (January 2009)
Postpartum Depressive Symptoms and Smoking Relapse Alicia M. Allen, MPHb, Cheryl B. Prince, PhDa, Patricia M. Dietz, DrPHa

"Background
Smokers with depressive symptoms are more likely to relapse after attempting to quit than those without depressive symptoms. Little is known about the relationship between depressive symptoms and relapse during the postpartum period; thus the aim of the present study is to assess the relationship between postpartum smoking relapse and depressive symptoms.
Methods
Analysis of 2004 Pregnancy Risk Assessment Monitoring System (PRAMS) data from women in 16 states who reported smoking 3 months before pregnancy and reported abstinence from smoking during the last 3 months of pregnancy (n=2566). For women experiencing postpartum depressive symptoms, chi-square tests were computed for homogeneity of distribution between two groups (sustained abstinence versus relapsed) and an OR for relapsing during the postpartum period. Potential confounders, including demographic characteristics, intensity of smoking before pregnancy, and time since delivery, were computed.
Results
Compared to women who did not experience postpartum depressive symptoms, women who did were 1.86 (95% CI=1.31, 2.65) times as likely to relapse during the postpartum period. After adjusting for demographic characteristics, intensity of smoking, and time since delivery, the association decreased slightly (adjusted OR=1.77, 95% CI=1.21, 2.59).
Conclusions
Women who quit smoking during pregnancy may be more likely to relapse if they experience depressive symptoms. Further research is needed into the screening and treatment of postpartum depressive symptoms as a possible method for preventing postpartum smoking relapse."

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BrooklynDodger(s) comment: Health risk behavior, such as smoking, is clearly associated with adverse outcomes. Many health "promotion" messages and programs blame the victim for the adverse outcome because the victim engages in health risk behavior. These messages and programs rely on exhortation as the major intervention.
The Dodger(s) contend(s) that a better strategy is to intervene on the causes of the risk behavior. Stress is widely believed to cause risk behavior, pain should be understood to be a stressor. A series of posts will argue that musculoskeletal pain is a cause of risk behavior and is responsible for health risk behavior. But the plausibility of this argument depends on the generality of the observation that the stressor precedes the risk behavior.
This post quotes a study which observed that newly arising depression or depressive symptoms is associated with smoking relapse. The Dodger(s) consider(s) depression or depressive symptoms to be a form of pain. The Dodger(s) also note that prevalence of smoking in a population depends on the balance between smokers quitting and ex-smokers starting again. Likely there are few newly starting smoking among forty-somethings.