May is Mental Health Awareness Month and for this newsletter, we would like to highlight the importance of promoting maternal mental health for nicotine cessation. According to recent data from the Pregnancy Risk Assessment Monitoring System, about 50% of women who smoked cigarettes prior to pregnancy continued to smoke during pregnancy.1 Additionally, an estimated 1 in 10 pregnant women smoke during the last trimester of pregnancy.2 An important context to consider is that many people who are pregnant or new parents experience stressors and mental health complications, including depression, anxiety, and trauma that may contribute to unhealthy coping, including nicotine use.3 Parents with lower economic resources, and who were also depressed, are at increased risk for smoking during pregnancy and have a lower likelihood of quitting.1 For mothers and parents who experience emotional and psychological challenges and are trying to quit nicotine without adequate support and resources, the consequences can potentially impact the entire family.
Those of us who work in nicotine treatment understand that the desire to quit does not always translate into immediate behavioral modification. As a psychologist who works in maternal mental health, I advocate that all moms and birthing people have access to individual or group therapy, medication as needed, peer support, and other mental health resources. There are so many life circumstances that make pregnancy and early parenting challenging and there is a need for adequate emotional support. However, mental health resources are not adequate for changing the landscape of maternal mental health, especially as it relates to nicotine treatment.
Support for new parents who have mental health complications or diagnoses and who are also trying to stop using nicotine products requires the use of a systemic approach. In addition to offering nicotine education and mental health resources, it is important for us to understand the unique basic needs of each person we treat. Where there is a lack of basic necessities (e.g., food, housing, finances), an effort must be made to meet these needs. Where there are challenges with life stressors, we must work to help parents find solutions that work for them. These considerations are essential to sustain nicotine cessation initiatives. So, our charge this month is to expand our conceptualization of effective, long-term nicotine treatment interventions, to include, but not be limited to mental health resources and support when needed.
- Allen, A. M., Jung, A. M., Lemieux, A., Alexander, A. C., Allen, S. S., Ward, K. D., & Al’Absi, M. (2019). Stressful life events are associated with perinatal cigarette smoking. Preventive Medicine, 118, 264–271. https://doi.org/10.1016/j.ypmed.2018.11.012
- Tong, V. T., Farr, S. L., Bombard, J. M., DʼAngelo, D., Ko, J. Y., & England, L. J. (2016). Smoking Before and During Pregnancy Among Women Reporting Depression or Anxiety. Obstetrics & Gynecology, 128(3), 562–570. https://doi.org/10.1097/aog.0000000000001595
- Jones, A. R., Carter-Harris, L., Stiffler, D., Macy, J. T., Staten, L. K., & Shieh, C. (2020b). Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 49(4), 361–372. https://doi.org/10.1016/j.jogn.2020.05.006