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SHS-Related Pediatric Sick Visits are Linked to Maternal Depressive Symptoms Among Low-Income African American Smokers: Opportunity for Intervention in Pediatrics

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Abstract

Maternal smoking and depressive symptoms are independently linked to poor child health outcomes. However, little is known about factors that may predict maternal depressive symptoms among low-income, African American maternal smokers—an understudied population with children known to have increased morbidity and mortality risks. The objective of this study was to test the hypothesis that secondhand smoke exposure (SHSe)-related pediatric sick visits are associated with significant maternal depressive symptoms among low-income, African American maternal smokers in the context of other depression-related factors. Prior to randomization in a behavioral counseling trial to reduce child SHSe, 307 maternal smokers in Philadelphia completed the Center for Epidemiologic Studies Depression (CES-D) and questionnaires measuring stressful events, nicotine dependence, social support, child health and demographics. CES-D was dichotomized at the clinical cutoff to differentiate mothers with significant versus low depressive symptoms. Results from direct entry logistic regression demonstrated that maternal smokers reporting more than one SHSe-related sick visit (OR 1.38, p < .001), greater perceived life stress (OR 1.05, p < .001) and less social support (OR 0.82, p < .001) within the last 3 months were more likely to report significant depressive symptoms than mothers with fewer clinic visits, less stress, and greater social support. These results suggest opportunities for future hypothesis-driven evaluation, and exploration of intervention strategies in pediatric primary care. Maternal depression, smoking and child illness may present as a reciprocally-determined phenomenon that points to the potential utility of treating one chronic maternal condition to facilitate change in the other chronic condition, regardless of which primary presenting problem is addressed. Future longitudinal research could attempt to confirm this hypothesis.

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Acknowledgments

This study was funded by the National Institutes of Health, National Cancer Institute grants CA93756 and CA105183 to BN Collins.

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  1. Department of Public Health, Health Behavior Research Clinic, Temple University, 929 Ritter Annex, 1301 Cecil B. Moore Ave., Philadelphia, PA, 19122, USA

    Bradley N. Collins, Uma S. Nair, Michelle Shwarz & Karen Jaffe

  2. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Jonathan Winickoff

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  1. Bradley N. Collins
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Collins, B.N., Nair, U.S., Shwarz, M. et al. SHS-Related Pediatric Sick Visits are Linked to Maternal Depressive Symptoms Among Low-Income African American Smokers: Opportunity for Intervention in Pediatrics. J Child Fam Stud 22, 1013–1021 (2013). https://doi.org/10.1007/s10826-012-9663-4

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