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Pregnant smokers who quit, pregnant smokers who don't: does history of problem behavior make a difference?


  • Wakschlag, Lauren S.
  • Pickett, Kate E.
  • Middlecamp, Molly K.
  • Walton, Laura L.
  • Tenzer, Penny
  • Leventhal, Bennett L.


More than half of women who smoke in the USA continue to do so while pregnant. While socioeconomic and demographic factors that distinguish pregnancy quitters from persistent smokers have been identified, less is known about behavioral factors that are associated with persistent smoking. Because smoking during pregnancy is not only an individual, but also a maternal behavior, it may have different behavioral correlates than women's smoking has in general. We propose a conceptual framework in which smoking during pregnancy is viewed as a maternal problem behavior. We explore this conceptualization by examining whether persistent smoking during pregnancy is associated with a pattern of psychosocial risk- and health-compromising behaviors in multiple domains, with pilot data from a small clinic-based sample. Data are presented for 96 predominantly Caucasian, working-class pregnant women recruited from prenatal clinics in the USA. Smoking during pregnancy was measured repeatedly by self-report and biochemical assay. Participants were non-smokers (37%), pregnancy quitters (17%), and persistent smokers (46%). These groups were compared in terms of their history of problem behavior in three domains: interpersonal difficulties, problems in adaptive functioning and problematic health behaviors. With few exceptions, smokers were more likely to have problematic relationships, poorer adaptive functioning and to engage in problematic health behaviors, than both pregnancy quitters and non-smokers. This pattern of problem behavior may interfere with the effectiveness of standard public health prenatal cessation interventions for a sub-group of women. Examining pregnancy smoking as part of a broader matrix of problem behavior may help to identify pregnant women most at risk for persistent smoking and inform the development of targeted interventions.

Suggested Citation

  • Wakschlag, Lauren S. & Pickett, Kate E. & Middlecamp, Molly K. & Walton, Laura L. & Tenzer, Penny & Leventhal, Bennett L., 2003. "Pregnant smokers who quit, pregnant smokers who don't: does history of problem behavior make a difference?," Social Science & Medicine, Elsevier, vol. 56(12), pages 2449-2460, June.
  • Handle: RePEc:eee:socmed:v:56:y:2003:i:12:p:2449-2460

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    Cited by:

    1. Shoff, Carla & Yang, Tse-Chuan, 2013. "Understanding maternal smoking during pregnancy: Does residential context matter?," Social Science & Medicine, Elsevier, vol. 78(C), pages 50-60.
    2. Sara Markowitz & E. Kathleen Adams & Patricia M. Dietz & Viji Kannan & Van Tong, 2011. "Smoking Policies and Birth Outcomes: Estimates From a New Era," NBER Working Papers 17160, National Bureau of Economic Research, Inc.
    3. Yang, Tse-Chuan & Shoff, Carla & Noah, Aggie J. & Black, Nyesha & Sparks, Corey S., 2014. "Racial segregation and maternal smoking during pregnancy: A multilevel analysis using the racial segregation interaction index," Social Science & Medicine, Elsevier, vol. 107(C), pages 26-36.
    4. Kiernan, Kathleen & Pickett, Kate E., 2006. "Marital status disparities in maternal smoking during pregnancy, breastfeeding and maternal depression," Social Science & Medicine, Elsevier, vol. 63(2), pages 335-346, July.


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