Objective: To describe factors associated with smoking status of low-income women during pregnancy and postpartum. Methods: Data from a randomized clinical trial were used to conduct separate analyses on 327 women who smoked at baseline (time at enrollment) and for whom smoking status was available at delivery, and on 109 women who reported not smoking at delivery (quit spontaneously or after study enrollment) and for whom smoking status was available at 6-months postpartum. Salivary cotinine was used to assess the accuracy of self-reported smoking status for the sample as a whole. Data were collected between May 1997 and November 2000. Results: 18% of the 327 baseline smokers stopped smoking before delivery. Cessation was less likely in older women, those reporting Medicaid coverage (vs. commercial or no insurance), who were at a later week of pregnancy at baseline, were more addicted, had a husband/partner who smoked, and did not receive the study intervention. 37% of the 109 women who reported not smoking at delivery maintained abstinence at 6-months postpartum. Factors associated with abstinence were later week of pregnancy at baseline and quitting spontaneously with pregnancy, while women who lived with a smoker were less likely to report abstinence. Spontaneous quitters were less likely to relapse by 6 months postpartum than women who quit smoking later in pregnancy. Conclusions: Partner participation in smoking cessation programs for pregnant and postpartum women merits exploration. Lower relapse rates among spontaneous quitters indicate a need to foster an environment that encourages quitting at pregnancy.
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REFERENCES
Wakschlag LS, Pickett KE, Cook E Jr., Benowitz NL, Leventhal BL. Maternal smoking during pregnancy and severe antisocial behavior in offspring: A review. Am J Public Health 2002;92:966–74.
Saglani S, McKenzie SA. Environmental factors relevant to difficult asthma. Paediatr Respir Rev 2002;3:248–54.
von Mutius E. Environmental factors influencing the development and progression of pediatric asthma. J Allergy Clin Immunol 2002;109:S525–32.
Lwebuga-Mukasa JS, Wojcik R, Dunn-Georgiou E, Johnson C. Home environmental factors associated with asthma prevalence in two Buffalo inner-city neighborhoods. J Health Care Poor Underserved 2002;13:214–28.
Jaakkola JJ, Gissler M. Maternal smoking in pregnancy, fetal development, and childhood asthma. Am J Public Health 2004;94:136–40.
U.S. Department of Health and Human Services. Women and smoking—A report of the surgeon general. Reckville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001.
Fingerhut L, Kleinman J, Kendrick J. Smoking before, during, and after pregnancy. Am J Public Health 1990;80:541–544.
Colman GJ, Joyce T. Trends in smoking before, during, and after pregnancy in ten states. Am J Prev Med 2003;24:29–35.
Brenner H, Mielck A. The role of childbirth in smoking cessation. Prev Med 1993;22:225–36.
Ockene J, Ma Y, Zapka J, Pbert L, Valentine Goins K, Stoddard A. Spontaneous cessation of smoking and alcohol use among low-income pregnant women. Am J Prev Med 2002;23:150–9.
Windsor R, Cutter G, Morris J, Reese Y, Manzella B, Bartlett E, Samuelson C, Spanos D. The effectiveness of smoking cessation methods for smokers in public health maternity clinics: A randomized trial. Am J Public Health 1985;75:1389–92.
Ershoff DH, Mullen PD, Quinn VP. A randomized trial of a serialized self-help smoking cessation program for pregnant women in an HMO. Am J Public Health 1989;79:182–7.
LeClere F, Wilson J. Smoking behavior of recent mothers, 18–44 years of age, before and after pregnancy: United States, 1990, 1997.
Studies OoA. Preliminary results from the 1996 Household Survey on Drug Abuse. Reckville, MD: U.S. Department of Health and Human Services, Public Health Service, 1997 (report (SMA) 97-3149).
Woodby L, Windsor R, Snyder S, Kohler C, Diclemente C. Predictors of smoking cessation during pregnancy. Addiction 1999;94:283–92.
Madeley RJ, Gillies PA, Power FL, Symonds EM. Nottingham mothers stop smoking project—Baseline survey of smoking in pregnancy. Community Med 1989;11:124–30.
Stewart PJ, Dunkley GC. Smoking and health care patterns among pregnant women. CMAJ 1985;133:989–94.
Quinn VP, Mullen PD, Ershoff DH. Women who stop smoking spontaneously prior to prenatal care and predictors of relapse before delivery. Addict Behav 1991;16:29–40.
Connor SK, McIntyre L. The sociodemographic predictors of smoking cessation among pregnant women in Canada. Can J Public Health 1999;90:352–5.
Molgaard CA, Laniado-Laborin R, Elder JP, De Moor C. The social epidemiology of smoking during pregnancy among Mexican women. NY State J Med 1989;89:15–18.
Olsen J. Predictors of Smoking Cessation in Pregnancy. Scand J Soc Med 1993;21:197–202.
Ludman EJ, McBride CM, Nelson JC, Curry SJ, Grothaus LC, Lando HA, Pirie PL. Stress, depressive symptoms, and smoking cessation among pregnant women. Health Psychol 2000;19:21–7.
Hakansson A, Lendahls L, Petersson C. Which women stop smoking? A population-based study of 403 pregnant smokers. Acta Obstet Gynecol Scand 1999;78:217–24.
Yu SM, Park CH, Schwalberg RH. Factors associated with smoking cessation among U.S. pregnant women. Matern Child Health J 2002;6:89–97.
Kahn RS, Certain L, Whitaker RC. A reexamination of smoking before, during, and after pregnancy. Am J Public Health 2002;92:1801–8.
Sexton M, Hebel JR. A clinical trial of change in maternal smoking and its effect on birth weight. JAMA 1984;251:911–5.
Windsor RA, Lowe JB, Perkins LL, Smith-Yoder D, Artz L, Crawford M, Amburgy K, Boyd NR Jr. Health education for pregnant smokers: Its behavioral impact and cost benefit. Am J Public Health 1993;83:201–6.
Dolan-Mullen P, Ramirez G, Groff JY. A meta-analysis of randomized trials of prenatal smoking cessation interventions. Am J Obstet Gynecol 1994;171:1328–34.
Carmichael SL, Ahluwalia IB. Correlates of postpartum smoking relapse. Results from the pregnancy risk assessment monitoring system (PRAMS). Am J Prev Med 2000;19:193–6.
McBride CM, Pirie PL. Postpartum smoking relapse. Addict Behav 1990;15:165–8.
Mullen PD, Quinn VP, Ershoff DH. Maintenance of nonsmoking postpartum by women who stopped smoking during pregnancy. Am J Public Health 1990;80:992–4.
Mullen PD, Richardson MA, Quinn VP, Ershoff DH. Postpartum return to smoking: Who is at risk and when. Am J Health Promot 1997;11:323–30.
Pbert L, Ockene J, Zapka J, Ma Y, Goins K, Oncken C, Stoddard A. A community health center smoking cessation intervention for pregnant and postpartum women. Am J Prev Med 2004;26:377–85.
Fiore M, Bailey W, Cohen S. Treating tobacco use and dependence. Clinical practice guidelines. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, 2000.
Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall, 1986.
Orleans CT, Barker DC, Kaufman NJ, Marx JF. Helping pregnant smokers quit: Meeting the challenge in the next decade. Tob Control 2000;9(Suppl 3):III6–11.
Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom test for nicotine dependence: A revision of the Fagerstrom tolerance questionnaire. Br J Addict 1991;86:1119–27.
McBride C, Curry S, Lando H, Pirie P, Grothaus L, Nelson J. Prevention of relapse in women who quit smoking during pregnancy. Am J Public Health 1999;89:706–11.
Murray D. Design and analysis of group randomized trials. New York, NY: Oxford University Press, 1998.
Wolfinger R, O'Connell M. Generalized linear models: A pseudo-likelihood approach. J Stat Comput Sim 1993;48:233–243.
Lu Y, Tong S, Oldenburg B. Determinants of smoking and cessation during and after pregnancy. Health Promot Int 2001;16:355–65.
Pirie P, Lando H, Curry S, McBride C, LC G. Tobacco, alcohol, and caffeine use and cessation in early pregnancy. Am J Prev Med 2000;18:54–61.
ACKNOWLEDGMENTS
The project described was supported by grant R01-HL51319-03 to Dr. Judith K. Ockene from the National Heart, Lung, and Blood Institute (NHLBI). The study received its initial Institutional Review Board approval in April 1993. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI. The authors wish to thank the Massachusetts WIC office under the leadership of Jan Kallio for its support and the research assistants (Evangelina Alvarez, Jessica Amador, Estenia Parsons, Janet Raphaelson, Nancy Smith) who collected the data. The authors are indebted to the women and the health centers who participated in this study.
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Ma, Y., Goins, K.V., Pbert, L. et al. Predictors of Smoking Cessation in Pregnancy and Maintenance Postpartum in Low-Income Women. Matern Child Health J 9, 393–402 (2005). https://doi.org/10.1007/s10995-005-0020-8
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DOI: https://doi.org/10.1007/s10995-005-0020-8