The Importance of Social Networks on Smoking: Perspectives of Women Who Quit Smoking During Pregnancy


While up to 45% of women quit smoking during pregnancy, nearly 80% return to smoking within a year after delivery. Interventions to prevent relapse have had limited success. The study objective was to understand what influences return to smoking after pregnancy among women who quit smoking during pregnancy, with a focus on the role of social networks. We conducted in-depth, semi-structured interviews during the postpartum hospital stay with women who quit smoking while pregnant. Over 300 pages of transcripts were analyzed using qualitative methods to identify common themes. Respondents [n = 24] were predominately white (63%), had at least some college education (54%) and a mean age of 26 years (range = 18–36). When reflecting on the experience of being a smoker who quit smoking during pregnancy, all participants emphasized the importance of their relationships with other smokers and the changes in these relationships that ensued once they quit smoking. Three common themes were: (1) being enmeshed in social networks with prominent smoking norms (2) being tempted to smoke by members of their social networks, and (3) changing relationships with the smokers in their social networks as a result of their non-smoking status. We found that women who quit smoking during pregnancy found themselves confronted by a change in their social network since most of those in their social network were smokers. For this reason, smoking cessation interventions may be most successful if they help women consider restructuring or reframing their social network.

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  1. 1.

    Carmichael, S. L., & Ahluwalia, I. B. (2000). Correlates of postpartum smoking relapse. Results from the Pregnancy Risk Assessment Monitoring System (PRAMS). American Journal of Preventative Medicine, 19, 193–196.

    Article  CAS  Google Scholar 

  2. 2.

    Von Kohorn, I., Nguyen, S. N., Shulman-Green, D., & Colson, E. R. A qualitative study of postpartum mothers' intention to smoke. Birth (in press).

  3. 3.

    Nichter, M., et al. (2008). Smoking and harm-reduction efforts among postpartum women. Qualitative Health Research, 18, 1184–1194.

    PubMed  Article  Google Scholar 

  4. 4.

    DiFranza, J., Aligne, C., & Weitzman, M. (2004). Prenatal and postnatal environmental tobacco smoke exposure and children’s health. Pediatrics, 113, 1007–1015.

    PubMed  Google Scholar 

  5. 5.

    Fleming, P., & Blair, P. S. (2007). Sudden infant death syndrome and parental smoking. Early Human Development, 83, 721–725.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Groner, J., et al. (2005). Screening for children’s exposure to environmental tobacco smoke in a pediatric primary care setting. Archives of Pediatrics & Adolescent Medicine, 159, 450–455.

    Article  Google Scholar 

  7. 7.

    Herrmann, M., King, K., & Weitzman, M. (2008). Prenatal tobacco smoke and postnatal secondhand smoke exposure and child neurodevelopment. Current Opinion in Pediatrics, 20, 184–190.

    PubMed  Article  Google Scholar 

  8. 8.

    Kum-Nji, P., Meloy, L., & Herrod, H. (2006). Environmental tobacco smoke exposure: Prevalence and mechanisms of causation of infections in children. Pediatrics, 117, 1745–1754.

    PubMed  Article  Google Scholar 

  9. 9.

    Lam, T., Leung, G., & Ho, L. (2001). The effects of environmental tobacco smoke on health services utilization in the first eighteen months of life. Pediatrics, 107, E91.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Bottorff, J. L., et al. (2006). Couple dynamics during women’s tobacco reduction in pregnancy and postpartum. Nicotine & Tobacco Research, 8, 499–509.

    Article  Google Scholar 

  11. 11.

    Ripley-Moffitt, C. E., et al. (2008). Safe babies: A qualitative analysis of the determinants of postpartum smoke-free and relapse states. Nicotine & Tobacco Research, 10, 1355–1364.

    Article  Google Scholar 

  12. 12.

    Ashford, K. B., et al. (2009). Postpartum smoking relapse and secondhand smoke. Public Health Reports, 124, 515–526.

    PubMed  Google Scholar 

  13. 13.

    Gaffney, K. F., & Henry, L. L. (2007). Identifying risk factors for postpartum tobacco use. Journal of Nursing Scholarship, 39, 126–132.

    PubMed  Article  Google Scholar 

  14. 14.

    Lemola, S., & Grob, A. (2008). Smoking cessation during pregnancy and relapse after childbirth: The impact of the grandmother’s smoking status. Maternal & Child Health Journal, 12, 525–533.

    Article  Google Scholar 

  15. 15.

    Solomon, L. J., et al. (2007). Predictors of postpartum relapse to smoking. Drug & Alcohol Dependence, 90, 224–227.

    Article  Google Scholar 

  16. 16.

    McBride, C. M., & Pirie, P. L. (1990). Postpartum smoking relapse. Addictive Behaviors, 15, 165–168.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Mullen, P. D. (2004). How can more smoking suspension during pregnancy become lifelong abstinence? Lessons learned about predictors, interventions, and gaps in our accumulated knowledge. Nicotine & Tobacco Research, 6(Suppl. 2), S217–S238.

    Article  Google Scholar 

  18. 18.

    Christakis, N., & Fowler, J. (2008). The collective dynamics of smoking in a large social network. New England Journal of Medicine, 358, 2249–2258.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Heaney, C. A., & Israel, B. A. (2002). Social networks and social support. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health behavior and health education: Theory, research, and practice (3rd ed., pp. 185–209). San Francisco, CA: Wiley.

    Google Scholar 

  20. 20.

    Levitt, C., et al. (2007). Systematic review of the literature on postpartum care: Effectiveness of interventions for smoking relapse prevention, cessation, and reduction in postpartum women. Birth, 34, 341–347.

    PubMed  Article  Google Scholar 

  21. 21.

    Helfer, R. E. (1987). The perinatal period, a window of opportunity for enhancing parent-infant communication: An approach to prevention. Child Abuse & Neglect, 11, 565–579.

    Article  CAS  Google Scholar 

  22. 22.

    Suplee, P. D. (2005). The importance of providing smoking relapse counseling during the postpartum hospitalization. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 34, 703–712.

    Article  Google Scholar 

  23. 23.

    Curry, L. A., et al. (2009). Qualitative and mixed methods provide unique contributions to outcomes research. Circulation, 119, 1442–1452.

    PubMed  Article  Google Scholar 

  24. 24.

    Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Hawthorne, NY: Aldine Transaction.

    Google Scholar 

  25. 25.

    Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research, 42, 1758–1772.

    PubMed  Article  Google Scholar 

  26. 26.

    Giacomini, M. K., & Cook, D. J. (2000). Users’ guides to the medical literature: XXIII. Qualitative research in health care. Are the results of the study valid? Evidence-Based Medicine Working Group. Journal of the American Medical Association, 284, 357–362.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.

    Article  Google Scholar 

  28. 28.

    Gantt, C. J. (2001). The theory of planned behavior and postpartum smoking relapse. Journal of Nursing Scholarship, 33, 337–341.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Charmaz, K. (2003). Grounded Theory: Objectivist and Constructivist Methods. In N. K. Denzin & Y. S. Lincoln (Eds.), Strategies of qualitative inquire (2nd ed., pp. 249–291). Thousand Oaks, CA: Sage.

    Google Scholar 

  30. 30.

    Ma, Y., et al. (2005). Predictors of smoking cessation in pregnancy and maintenance postpartum in low-income women. Maternal & Child Health Journal, 9, 393–402.

    Article  Google Scholar 

  31. 31.

    Mullen, P. D., Richardson, M. A., Quinn, V. P., & Ershoff, D. H. (1997). Postpartum return to smoking: Who is at risk and when. American Journal of Health Promotion, 11, 323–330.

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Mishel, M., & Braden, C. (1987). Uncertainty: A mediator between support and adjustment. Western Journal of Nursing Research, 9, 43–57.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Palmer, C. A., et al. (2000). Couple approaches to smoking cessation. In K. B. Schmaling & T. G. Sher (Eds.), The psychology of couples and illness: Theory, research, and practice (pp. 311–336). Washington, DC: American Psychological Association.

    Google Scholar 

  34. 34.

    Levine, M. D. (2008). Women’s interest in treatment to stay abstinent from cigarettes postpartum. Women’s Health Issues, 18, 381–386.

    PubMed  Article  Google Scholar 

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This work was supported in part by the National Institute of Child Health and Human Development (T32HD07094); the American Academy of Pediatrics/Flight Attendants’ Medical Research Institute—Fellowship Award and the Yale University School of Medicine Short Term Research Fellowship. The responsibility for the content of this article rests with the authors and does not necessarily represent the views of the Institute of Medicine or its committees. The authors would like to acknowledge Eugene Shapiro MD, Leslie Curry PhD, Marcella Nuñez-Smith MD, and the nurses and staff of Yale-New Haven Hospital West Pavilion Floors 10 and 11 for their insights and support during the completion of the project. Finally, we would like to thank the women who participated in this study. By giving their time, insight, and suggestions, they may help other women achieve lifelong smoking cessation.

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Correspondence to Eve R. Colson.

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Nguyen, S.N., Von Kohorn, I., Schulman-Green, D. et al. The Importance of Social Networks on Smoking: Perspectives of Women Who Quit Smoking During Pregnancy. Matern Child Health J 16, 1312–1318 (2012).

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  • Smoking
  • Postpartum
  • Qualitative
  • Relapse