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The Co-Occurrence of Maternal Depressive Symptoms and Smoking in a National Survey of Mothers

  • Megan Kavanaugh
    Affiliations
    From the American Academy of Pediatrics (Drs Kavanaugh and Weitzman), Center for Child Health Research, Rochester, NY; University of Rochester School of Medicine and Dentistry (Dr Kavanaugh), Rochester, NY; Social Science Research Center (Drs McMillen and Southward), Mississippi State University, Starkville, Miss; Tobacco Consortium (Drs McMillen, Winickoff and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; Department of Pediatrics (Dr Pascoe), Wright State University School of Medicine and The Children's Medical Center, Dayton, Ohio; Health, Early Care and Education Consortium (Drs Pascoe, Southward, and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; MGH Center for Child and Adolescent Health Policy (Dr Winickoff), General Pediatrics Division, MassGeneral Hospital for Children, Boston, Mass; Tobacco Research and Treatment Center (Dr Winickoff), MassGeneral Hospital, Boston, Mass; and Strong Children's Research Center (Dr Weitzman), Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • Robert C. McMillen
    Affiliations
    From the American Academy of Pediatrics (Drs Kavanaugh and Weitzman), Center for Child Health Research, Rochester, NY; University of Rochester School of Medicine and Dentistry (Dr Kavanaugh), Rochester, NY; Social Science Research Center (Drs McMillen and Southward), Mississippi State University, Starkville, Miss; Tobacco Consortium (Drs McMillen, Winickoff and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; Department of Pediatrics (Dr Pascoe), Wright State University School of Medicine and The Children's Medical Center, Dayton, Ohio; Health, Early Care and Education Consortium (Drs Pascoe, Southward, and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; MGH Center for Child and Adolescent Health Policy (Dr Winickoff), General Pediatrics Division, MassGeneral Hospital for Children, Boston, Mass; Tobacco Research and Treatment Center (Dr Winickoff), MassGeneral Hospital, Boston, Mass; and Strong Children's Research Center (Dr Weitzman), Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • John M. Pascoe
    Affiliations
    From the American Academy of Pediatrics (Drs Kavanaugh and Weitzman), Center for Child Health Research, Rochester, NY; University of Rochester School of Medicine and Dentistry (Dr Kavanaugh), Rochester, NY; Social Science Research Center (Drs McMillen and Southward), Mississippi State University, Starkville, Miss; Tobacco Consortium (Drs McMillen, Winickoff and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; Department of Pediatrics (Dr Pascoe), Wright State University School of Medicine and The Children's Medical Center, Dayton, Ohio; Health, Early Care and Education Consortium (Drs Pascoe, Southward, and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; MGH Center for Child and Adolescent Health Policy (Dr Winickoff), General Pediatrics Division, MassGeneral Hospital for Children, Boston, Mass; Tobacco Research and Treatment Center (Dr Winickoff), MassGeneral Hospital, Boston, Mass; and Strong Children's Research Center (Dr Weitzman), Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • Linda Hill Southward
    Affiliations
    From the American Academy of Pediatrics (Drs Kavanaugh and Weitzman), Center for Child Health Research, Rochester, NY; University of Rochester School of Medicine and Dentistry (Dr Kavanaugh), Rochester, NY; Social Science Research Center (Drs McMillen and Southward), Mississippi State University, Starkville, Miss; Tobacco Consortium (Drs McMillen, Winickoff and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; Department of Pediatrics (Dr Pascoe), Wright State University School of Medicine and The Children's Medical Center, Dayton, Ohio; Health, Early Care and Education Consortium (Drs Pascoe, Southward, and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; MGH Center for Child and Adolescent Health Policy (Dr Winickoff), General Pediatrics Division, MassGeneral Hospital for Children, Boston, Mass; Tobacco Research and Treatment Center (Dr Winickoff), MassGeneral Hospital, Boston, Mass; and Strong Children's Research Center (Dr Weitzman), Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • Jonathan P. Winickoff
    Affiliations
    From the American Academy of Pediatrics (Drs Kavanaugh and Weitzman), Center for Child Health Research, Rochester, NY; University of Rochester School of Medicine and Dentistry (Dr Kavanaugh), Rochester, NY; Social Science Research Center (Drs McMillen and Southward), Mississippi State University, Starkville, Miss; Tobacco Consortium (Drs McMillen, Winickoff and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; Department of Pediatrics (Dr Pascoe), Wright State University School of Medicine and The Children's Medical Center, Dayton, Ohio; Health, Early Care and Education Consortium (Drs Pascoe, Southward, and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; MGH Center for Child and Adolescent Health Policy (Dr Winickoff), General Pediatrics Division, MassGeneral Hospital for Children, Boston, Mass; Tobacco Research and Treatment Center (Dr Winickoff), MassGeneral Hospital, Boston, Mass; and Strong Children's Research Center (Dr Weitzman), Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • Michael Weitzman
    Correspondence
    Address correspondence to Michael Weitzman, MD, Center for Child Health Research, 1351 Mount Hope Avenue, Suite 130, Rochester, NY 14620
    Affiliations
    From the American Academy of Pediatrics (Drs Kavanaugh and Weitzman), Center for Child Health Research, Rochester, NY; University of Rochester School of Medicine and Dentistry (Dr Kavanaugh), Rochester, NY; Social Science Research Center (Drs McMillen and Southward), Mississippi State University, Starkville, Miss; Tobacco Consortium (Drs McMillen, Winickoff and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; Department of Pediatrics (Dr Pascoe), Wright State University School of Medicine and The Children's Medical Center, Dayton, Ohio; Health, Early Care and Education Consortium (Drs Pascoe, Southward, and Weitzman), American Academy of Pediatrics, Center for Child Health Research, Rochester, NY; MGH Center for Child and Adolescent Health Policy (Dr Winickoff), General Pediatrics Division, MassGeneral Hospital for Children, Boston, Mass; Tobacco Research and Treatment Center (Dr Winickoff), MassGeneral Hospital, Boston, Mass; and Strong Children's Research Center (Dr Weitzman), Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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      Context.—Both maternal smoking and depression are common and can adversely impact child health and functioning, yet few studies have explored their co-occurrence among mothers.
      Objective.—To determine the prevalence and associations of depression and smoking among mothers in the United States.
      Design.—Random-digit-dial national telephone survey of 1530 households conducted in 2002. Respondents were asked about their sociodemographic characteristics, smoking status, and their children's receipt of Medicaid. A validated 3-item depression screen was administered. Bivariate and multiple regression analyses for maternal smoking and a positive depression screen were performed.
      Setting.—National sample.
      Participants.—Seven hundred two mothers with children aged less than 19 years living in their homes.
      Results.—The response rate was 61%. Among mothers, 24.3% were smokers, 24.4% had a positive depression screen, 8.1% had both, and 40.6% were smokers and/or had a positive depression screen. All rates were greater among mothers whose children receive Medicaid (37.6%, 47.5%, 20.6%, and 64.5%) than those whose children do not receive Medicaid (21.1%, 19.0%, 4.8%, and 35.3%) (P < .001) for each. In multivariate analyses, maternal smoking was independently associated with a 70% increased risk of depressive symptoms (odds radio, 1.7; 95% confidence interval, 1.1–2.6).
      Conclusions.—This study highlights both the frequency and the co-occurrence of maternal smoking and maternal depressive symptoms, two negative influences on children's health and development, as well as their increased prevalence among mothers whose children receive Medicaid, thereby highlighting the economic disparities associated with both. These findings have significant implications for our nation's children, health care clinicians, and health care payers.

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