Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
University of Minnesota, Minneapolis, MN.
Nicotine Tob Res. 2020 Oct 29;22(11):2104-2108. doi: 10.1093/ntr/ntz189.
In general population samples, higher levels of stress and depression have been associated with increased prevalence of smoking in pregnancy. Little is known about the association of prenatal tobacco use, stress, and depression among American Indian or Alaska Native (AI/AN) women.
The Healthy Pregnancies Project is a cluster-randomized controlled trial, evaluating a community-level intervention compared with usual care, for reducing tobacco use during pregnancy and postpartum among AN women in 16 villages in western Alaska. This cross-sectional study analyzed baseline data from enrolled pregnant women. Baseline measures included the self-reported, 7-day, point-prevalence current use of any tobacco, Perceived Stress Scale (PSS), and the Center for Epidemiological Studies-Depression (CES-D). Generalized estimating equations (GEE) analyses adjusted for village, participant age, and gestational age.
Participants (N = 352) were on average (SD) 25.8 (5.0) years of age and at 26.8 (9.8) weeks gestation. 66.5% were current tobacco users, of which 77% used Iqmik, a homemade form of smokeless tobacco. Compared with nonusers, tobacco users reported lower PSS score (p = .020) and less clinical levels of depression (CES-D ≥ 16) (18.1% vs. 9.3%, p = .21). Findings were not accounted for by nicotine dependence severity or self-reported tobacco use before pregnancy.
In this sample of pregnant AN women, tobacco users report less stress and clinical levels of depression than nonusers. A potential challenge with tobacco treatment for pregnant AN women is to provide alternative ways of deescalating stress and affect management instead of using tobacco.
This study contributes novel information on the association of tobacco use, perceived stress, and depression among Alaska Native women enrolled in a clinical trial to promote healthy pregnancies. Most prior studies addressing this topic were conducted among general population samples of pregnant women who smoked cigarettes. Little is known about these associations with prenatal smokeless tobacco, or among American Indian or Alaska Native women. The results are contrary to findings reported previously, because current tobacco use was associated with less stress and depression than nonuse. The study findings have implications for cessation treatment for this tobacco-use disparity group.
在一般人群样本中，较高水平的压力和抑郁与怀孕期间吸烟的流行率增加有关。在美洲印第安人或阿拉斯加原住民（AI/AN）妇女中，产前烟草使用、压力和抑郁之间的关联知之甚少。
健康妊娠项目是一项集群随机对照试验，评估了一种社区层面的干预措施，与常规护理相比，该干预措施旨在减少阿拉斯加西部 16 个村庄的 AN 女性在怀孕期间和产后的烟草使用。这项横断面研究分析了入组孕妇的基线数据。基线测量包括自我报告的、7 天的、当前使用任何烟草的点患病率、感知压力量表（PSS）和流行病学研究中心抑郁量表（CES-D）。广义估计方程（GEE）分析调整了村庄、参与者年龄和妊娠周数。
参与者（N=352）的平均年龄（SD）为 25.8（5.0）岁，妊娠 26.8（9.8）周。66.5%是当前的烟草使用者，其中 77%使用 Iqmik，一种自制的无烟烟草形式。与非使用者相比，烟草使用者报告的 PSS 评分较低（p=0.020），临床抑郁水平较低（CES-D≥16）（18.1%比 9.3%，p=0.21）。这些发现与尼古丁依赖严重程度或怀孕前自我报告的烟草使用无关。
在本样本中，怀孕的 AN 女性中，烟草使用者报告的压力和临床抑郁水平低于非使用者。对于怀孕的 AN 女性的烟草治疗，一个潜在的挑战是提供替代的减轻压力和影响管理的方法，而不是使用烟草。
这项研究为在一项促进健康妊娠的临床试验中招募的阿拉斯加原住民妇女的烟草使用、感知压力和抑郁之间的关联提供了新的信息。大多数先前研究该主题的研究都是在一般人群的孕妇样本中进行的，这些孕妇吸烟。关于这种与产前无烟烟草的关联，或在美洲印第安人或阿拉斯加原住民妇女中，知之甚少。研究结果与以前报告的结果相反，因为当前的烟草使用与非使用相比，与压力较小和抑郁程度较低有关。研究结果对这一烟草使用差异群体的戒烟治疗具有启示意义。
