Learn about our group's current and past research!

 

Current Studies:

HABIT: Health and Behaviors In Transition

We are interested in learning more about health behaviors during and after pregnancy. We are conducting a study to test interventions for weight, health and well-being during pregnancy and/or during the postpartum period.

Interested?
Click below for more information:

Previously Completed Studies:

LEAP: Longitudinal Eating Assessment in Pregnancy

This study involves 300 women, and the purpose is to study psychological and other factors that may be related to weight gain in pregnancy.

SMART-Pilot:

This pilot study evaluated an intervention that addressed maternal weight, stress, and mood throughout pregnancy.

STARTS: Strategies to Avoid Returning to Smoking 

The goal of this investigation was to determine whether cognitive behavioral intervention designed to address mood and weight concerns postpartum will decrease the rate of postpartum relapse to smoking.  300 women were randomized to one of two different types of treatment: cognitive behavior therapy or supportive behavior therapy.  Participants were enrolled in the study between 32 and 36 weeks of pregnancy and received treatment every other week either in-person or by phone for 24 weeks following delivery.

STAYQUIT: Web and Phone Intervention to Maintain Postpartum Tobacco Abstinence 

The goal of this investigation was to develop an internet-based relapse prevention program that included telephone counseling to increase the number of women who sustain smoking abstinence after childbirth.

CBT4BN: Optimizing Technology in the Treatment of Bulimia Nervosa (CBT4BN)
This study compared the efficacy of a cognitive-behavioral internet-based treatment of individuals with bulimia nervosa to that of a standard, group cognitive behavioral treatment program.

Treating Postpartum Nicotine Dependence

The goals of this study were to examine the role of mood and weight concerns in relapses to smoking during the postpartum period and to develop a postpartum relapse prevention intervention that addressed factors found to be related to postpartum relapse.

Bupropion and Weight Concerns for Smoking Cessation

The goal of this randomized clinical trial was to investigate the combined effect of bupropion and a cognitive behavioral treatment for smoking cessation among women concerned about post-cessation weight gain.

PUBLICATIONS

HABIT
  • Trial design and methodology for a non-restricted sequential multiple assignment randomized trial to evaluate combinations of perinatal interventions to optimize women’s health
    • Pre-pregnancy overweight/obesity and excessive gestational weight gain (GWG) independently predict negative maternal and child health outcomes. To date, however, interventions that target GWG have not produced lasting improvements in maternal weight or health at 12-months postpartum. Given that interventions solely aimed at addressing GWG may not equip women with the skills needed for postpartum weight management, interventions that address health behaviors over the perinatal period might maximize maternal health in the first postpartum year. Thus, the current study leveraged a sequential multiple assignment randomized trial (SMART) design to evaluate sequences of prenatal (i.e., during pregnancy) and postpartum lifestyle interventions that optimize maternal weight, cardiometabolic health, and psychosocial outcomes at 12-months postpartum.
    • Germeroth et al. Contep Clin Trials. 2019 Apr. DOI: 10.1016/j.cct.2019.03.002
LEAP
  • Healthcare provider advice on gestational weight gain: uncovering a need for more effective weight counselling.
    • This study examined factors related to knowledge of gestational weight gain (GWG) recommendations and the receipt of advice from healthcare providers regarding GWG recommendations among women with pre-pregnancy overweight/obesity.
    • Emery et al. J Obstet Gynaecol. 2018 Oct. DOI: https://doi.org/10.1080/01443615.2018.1433647
  • Mothers’ loss of control over eating during pregnancy in relation to their infants’ appetitive traits
    • We were interested in prospectively examining mothers’ LOC during pregnancy in relation to their infants’ appetitive traits. In particular, we were interested in this relationship among women with overweight/obesity, given that their infants are at greater risk for obesity.
    • Kolko et al. Appetite. 2018 Jan 1. DOI: 10.1016/j.appet.2017.08.007
  • Adapting the eating disorder examination for use during pregnancy: Preliminary results from a community sample of women with overweight and obesity.
    • The Eating Disorder Examination (EDE) is a structured clinical interview that is widely used for assessing disordered eating. Although the EDE has been used in pregnant women, no standard pregnancy version has been developed. Accordingly, the present study aimed to document adaptations made to a pregnancy version of the EDE (EDE-PV) and to describe the internal reliability of this adapted version.
    • Emery et al. Int J Eat Disord. 2017 May. DOI: 10.1002/eat.22646
  • Loss of control over eating before and during early pregnancy among community women with overweight and obesity.
    • This study examined the prevalence of and changes in loss of control over eating (LOC) among pregnant women with overweight/obesity, along with associations between LOC and depressive symptoms and stress. LOC during pregnancy was prevalent and associated with distress, particularly when present before and during pregnancy
    • Kolko et al. Int J Eat Disord. 2016 Sep 23.DOI: 10.1002/eat.22630
STARTS
  • The Role of Self-Efficacy and Motivation in Postpartum Sustained Smoking Abstinence
    • Postpartum relapse to cigarette smoking is common and relapse prevention interventions have indicated limited efficacy. Abstinence motivations and self-efficacy are two factors that might fluctuate during the postpartum period and predict smoking abstinence. The present study was a secondary analysis that examined statistical trends in motivations and self-efficacy to sustain postpartum abstinence and evaluated their association with sustained abstinence from pregnancy through 52 weeks postpartum
    • Germeroth et al. Womens Health Issues. 2019 May 6. DOI: 10.1016/j.whi.2019.03.006
  • Do Psychiatric Disorders or Measures of Distress Moderate Response to Postpartum Relapse Prevention Interventions?
    • Most women who quit smoking during pregnancy will relapse postpartum. Interventions for sustained postpartum abstinence can benefit from understanding prenatal characteristics associated with treatment response. Given that individuals with psychiatric disorders or elevated depressive symptoms have difficulty quitting smoking and that increases in depressive symptoms prenatally are common, we examined the relevance of psychiatric diagnoses, prenatal depressive symptoms, and stress to postpartum relapse prevention intervention response.
    • Kolko et al. Nicotine Tob Res. 2017 May 1. DOI: 10.1093/ntr/ntw385
  • The Influence of Smoking on Breast feeding Among Women Who Quit Smoking During Pregnancy
    • Understanding factors related to breast-feeding intention, initiation, duration, and weaning among women who quit smoking as a result of pregnancy may inform interventions to increase breast-feeding rates among women who smoke.
    • Joseph et al. Nicotine Tob Res. 2017 May. DOI: 10.1093/ntr/ntw254
  • Optimal carbon monoxide criteria to confirm smoking status among postpartum women
    • Although expired-air carbon monoxide (CO) is a well characterized biomarker of cigarette smoking, limited research has assessed whether the standard clinical CO cutoffs need to be altered for postpartum women and whether these cutoffs remain constant across the postpartum year. Accordingly, the present study evaluated the effectiveness of using CO as a method to confirm smoking status relative to salivary cotinine among postpartum women and assessed optimal CO criteria to confirm smoking status across the postpartum year. Differences in optimal CO criteria to confirm smoking status also were examined between black and white postpartum women.
    • Emery et al. Nicotine & Tobacco Research. 2016 September 18. DOI: https://doi.org/10.1093/ntr/ntv196
  • Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial
    • Most women who quit smoking during pregnancy will relapse postpartum. Previous efforts to prevent postpartum relapse have been unsuccessful at increasing rates of sustained abstinence
    • Levine et al. JAMA Intern Med. 2016 Apr. DOI: 1001/jamainternmed.2016.0248
  • Prevalence and correlates of a lifetime cannabis use disorder among pregnant former tobacco smokers.
    • Following tobacco and alcohol, cannabis is the most commonly used substance during pregnancy. Given the high prevalence of concurrent cannabis and tobacco use as well as the health consequences associated with prenatal substance use, we sought to document the relative contributions of psychosocial and psychiatric factors commonly associated with cannabis use in predicting a lifetime cannabis use disorder (CUD) among women who had quit smoking tobacco as a result of pregnancy.
    • Emery et al. Addict Behav. 2016 Mar. PMCID: PMC4713331
  • Association of Restraint and Disinhibition to Gestational Weight Gain among Pregnant Former Smokers
    • The present study evaluated the relationship of dietary restraint and disinhibition to GWG in a sample of women (n=248) who quit smoking before or early in pregnancy.
    • Slane et al. Womens Health Issues. 2015 Jul-Aug. PMCID: PMC4492878
  • Psychiatric disorders and gestational weight gain among women who quit smoking during pregnancy
    • Pregnancy is a common time for women to quit using cigarettes and other substances. Such changes in substance use as well as other psychiatric and psychosocial changes during pregnancy can affect gestational weight gain (GWG). Thus, we evaluated the relationship between psychiatric disorders and GWG among pregnant women who had quit smoking.
    • Levine et al. J Psychosom Res. 2015 May. PMCID: PMC4380755
  • Strategies to Avoid Returning to Smoking (STARTS): A Randomized Controlled Trial of Postpartum Smoking Relapse Prevention Interventions Contemporary Clinical Trials
    • The majority of women who quit smoking during pregnancy relapse postpartum and many experience increased depressive symptoms and concerns about body shape and weight. Given the relationship between weight concerns and negative mood with smoking relapse, interventions designed to address the postpartum experience are indicated. The intervention described in this report is designed to address stress, negative mood and concerns about weight that mediate smoking relapse postpartum to sustain abstinence and improve maternal and infant health.
    • Levine et al. Contemp Clin Trials. 2013 Oct 17. PMCID: PMC3878443
ZYBAN
  • Predictive utility of subtyping women smokers on depression, eating, and weight-related symptoms
    • Smoking and overweight or obesity are preventable causes of disease and death. Women are reluctant to quit smoking because of concerns about postcessation weight gain, underscoring the need to elucidate patterns of weight concerns and associated psychosocial factors that may affect smoking cessation outcomes. The present study aimed to subtype women smokers based on psychosocial and behavioral factors associated with smoking and weight, and examine the utility of these subtypes to predict abstinence and postcessation weight gain.
    • Salk et al. Healt Psychol. 2019 Mar. DOI: 10.1037/hea0000702
  • Change in body weight does not mediate the relationship between exercise and smoking cessation among weight-concerned women smokers.
    • Exercise has received attention as a method to prevent or reduce post-cessation weight  However, little is known about how weight changes following quit attempts contribute to the relationship between exercise and smoking cessation. The present study assessed how exercise relates to cessation and whether initial changes in exercise after quitting smoking promote cessation through attenuated weight gain.
    • Emery et al. Nicotine Tob Res. 2015 Sep. PMCID: PMC4542740
  • A test of the stress-buffering model of social support in smoking cessation: Is the relationship between social support and time to relapse mediated by reduced withdrawal symptoms?
    • Social support has been linked to quitting smoking, but the mechanisms by which social support affects cessation are poorly understood. The current study tested a stress-buffering model of social support, which posits that social support protects or “buffers” individuals from stress related to quitting smoking. We hypothesized that social support would be negatively associated with risk of relapse, and that this effect would be mediated by reduced withdrawal and depressive symptoms (i.e., cessation-related stress) over time. Further, we predicted that trait neuroticism would moderate this mediational effect, such that individuals high in negative affectivity would show the greatest stress-buffering effects of social support.
    • Creswell et al. Nicotine Tob Res. 2015 May. PMCID: PMC4498137
  • Dietary intake after smoking cessation among weight-concerned women smokers.
    • Weight gain typically accompanies smoking cessation, and women smokers concerned about postcessation weight gain are prone to substantial gain. Little is known about the ways in which cessation affects dietary  Understanding postcessation changes in dietary composition may inform the design of smoking cessation interventions to address postcessation weight gain. Participants were women smokers concerned about postcessation weight gain enrolled in a randomized trial and assigned to either bupropion or placebo and to either standard cessation intervention or standard intervention plus components to address weight concerns.
    • Levine et al. Psychol Addict Behav. 2012 Dec 26. PMCID: PMC3475794
  • Subjective sleep disturbance during a smoking cessation program: Associations with relapse
    • Sleep disturbance may affect smoking cessation  We describe sleep changes across three months among women in a smoking cessation program and tested whether sleep disturbances at baseline and 1 month post-quit attempt predicted smoking status at three months.
    • Okun et al. Addict Behav. 2011 Aug. PMCID: PMC3588159
  • Bupropion and cognitive behavioral therapy for weight-concerned women smokers.
    • We previously documented that cognitive behavioral therapy for smoking-related weight concerns (CONCERNS) improves cessation rates. However, the efficacy of combining CONCERNS with cessation medication is unknown. We sought to determine if the combination of CONCERNS and bupropion therapy would enhance abstinence for weight-concerned women smokers.
    • Levine et al. Arch Intern Med. 2010 Mar 22. PMCID: PMC3113531
OTHER
  • Taste manipulation during a food cue-reactivity task: Effects on cue-elicited food craving and subsequent food intake among individuals with overweight and obesity
    • Food cue-reactivity tasks are used to induce and evaluate food cravings. Extant research has implicated the role of tasting foods in heightening cue-elicited food craving. The present study was the first to evaluate a taste manipulation during a food cue-reactivity task to optimize cue-elicited craving and predict food intake.
    • Germeroth et al. Eat Behav. 2019 March 29. DOI: 10.1016/j.eatbeh.2019.03.005
  • Postcessation weight gain concern as a barrier to smoking cessation: Assessment considerations and future directions
    • Concern about postcessation weight gain may be one potential barrier to quitting smoking. In this ‘mini-review’ of recent literature, we summarize findings on the relationship between postcessation weight gain concern and smoking cessation, and evaluate varied use of postcessation weight gain concern assessments and potential moderators of the postcessation weight gain concern-cessation association.
    • Germeroth LG, Levine MD. Addict Behav. 2018 Jan. DOI: 10.1016/j.addbeh.2017.08.022
  • Questionnaire and Behavioral Task Measures of Impulsivity are Differentially Associated With Body Mass Index: A Comprehensive Meta-Analysis
    • These meta-analytic findings demonstrate that impulsivity is positively associated with BMI and further document that this association varies by the type of impulsivity measure used and the domain of impulsivity assessed.
    • Emery, RL, Levine, MD. Psychol Bull. 2017 May. PMID: 28493725
    • Article PDF
    • Commentary on Meta-Analysis
  • Examining the effect of binge eating and disinhibition on compensatory changes in energy balance following exercise among overweight and obese women.
    • Some women behaviorally compensate for the energy expended during exercise by increasing their energy intake or becoming more sedentary, thereby decreasing their energy  Although behavioral compensation can attenuate or even reverse the energy deficit generated by exercise, few data are available on predictors of compensatory responses to exercise. The present study aimed to identify eating-related predictors of compensatory changes in energy balance following exercise.
    • Emery et al. Eat Behav. 2016 Aug. PMCID: PMC4983198