Research article
Spontaneous cessation of smoking and alcohol use among low-income pregnant women

https://doi.org/10.1016/S0749-3797(02)00492-0Get rights and content

Abstract

Background: Despite the strong evidence of harmful effects, tobacco and alcohol use during pregnancy continue to be major public health challenges. Some women, however, do stop spontaneously when they learn of their pregnancy. No study has investigated spontaneous cessation of both behaviors in a low-income predominantly unmarried U.S. population.

Objective: To describe the prevalence of spontaneous cessation of cigarette and alcohol use alone and in combination and associated factors among low-income pregnant women.

Methods: Subjects (N=601) were currently smoking or smoking when they became pregnant and participating in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs in the greater Boston, Massachusetts, area. Baseline interviews assessed the factors being studied and the spontaneous cessation of cigarette and alcohol use with pregnancy. Saliva cotinine verified self-reported smoking status.

Results: Spontaneous cessation of smoking and alcohol use was reported by 28% and 80% of the women, respectively; 25% spontaneously quit both, and 15% stopped neither. Multivariable analyses indicated that smoking cessation was less likely in women who had previous births, had a husband or partner who smoked, were born in the United States, were black (non-Hispanic, non-Portuguese), had less than a high school education, were highly addicted, reported lower perceived risk to the fetus, and reported “too many other problems in life to stop.” Hispanic ethnicity, younger age, and more social support to quit smoking were related to spontaneous alcohol abstinence.

Conclusions: Targeted multiple strategies, including those aimed at increasing participation of partners, are needed for low-income pregnant smokers.

Section snippets

Background

Deleterious effects of cigarette and alcohol use on the fetus during pregnancy are unequivocal. Smoking increases the rate of low birth weight and premature birth,1, 2 fetal and infant mortality,3 sudden infant death syndrome, asthma, upper respiratory infections, and hospitalization for pneumonia or bronchitis.4, 5, 6, 7 Alcohol use during pregnancy is a major cause of preventable mental retardation8, 9 and intrauterine growth retardation.4, 10, 11 The co-occurrence of cigarette and alcohol

Subjects and data collection

Study participants were enrolled in a randomized clinical trial, Quit Together (QT), studying the effect of a smoking intervention delivered by their usual prenatal healthcare providers. Baseline data were collected from May 1997 to December 1999 at five WIC offices in CHCs in the greater Boston, Massachusetts, area that offer prenatal and pediatric services to clients of diverse race/ethnicity. The majority of participants were enrolled prior to their first prenatal WIC appointment. Eligible

Results

As reported in Table 1, the study sample is ethnically and racially diverse. Most were unmarried or not living with a partner, not working, born in the United States, had Medicaid coverage, had a partner (or husband) who smoked, and experiencing a first pregnancy. Forty-one percent had less than a high school education.

Spontaneous quitting of smoking at pregnancy was reported by 27.6% (n=166) of the 601 women. Ninety-one percent of the cotinine values below the cut-point indicated correct

Discussion

The greater reported rate of spontaneous alcohol abstinence (80%) compared to smoking (27.6%) in this study is consistent with previous work.4, 23, 24, 38 The spontaneous smoking-cessation rate in our study is close to the national average (overall and by race/ethnicity). Several factors from four broad categories of variables (personal characteristics, substance use and tobacco addiction, attitudes/perceptions, and environmental context) were independently related to spontaneous cessation of

Acknowledgements

This project was supported by grant R01-HL51319-03 from the National Heart, Lung and Blood Institute (NHLBI). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI. We are grateful to the Massachusetts WIC office under the leadership of Jan Kallio for its support, as well as the research assistants (Evangelina Alvarez, Jessica Amador, Estenia Parsons, Janet Raphaelson, and Nancy Smith) who collected the data. We are also

References (50)

  • M. Malloy et al.

    The association of maternal smoking with age and cause of infant deaths

    Am J Epidemiol

    (1988)
  • X. Shu et al.

    Maternal smoking, alcohol drinking, caffeine consumption, and fetal growthresults from a prospective study

    Epidemiol

    (1995)
  • M. Schlaud et al.

    Smoking during pregnancy and poor antenatal caretwo major preventable risk factors for sudden infant death syndrome

    Int J Epidemiol

    (1996)
  • R. Walsh

    Effects of maternal smoking on adverse pregnancy outcomesexamination of the criteria of causation

    Hum Biol

    (1994)
  • W. Jedrychowski et al.

    Maternal smoking during pregnancy and postnatal exposure to environmental tobacco smoke as predisposition factors to acute respiratory infections

    Environ Health Perspect

    (1997)
  • A. Streissguth et al.

    Attention, distraction and reaction time at age 7 years and prenatal alcohol exposure

    Neurobehav Toxicol Teratol

    (1986)
  • J. Martin et al.

    Maternal alcohol ingestion and cigarette smoking and their effects on newborn conditioning

    Alcohol Clin Exp Res

    (1977)
  • Healthy People 2010

    (2000)
  • F. LeClere et al.

    Smoking behavior of recent mothers, 18–44 years of age, before and after pregnancyUnited States, 1990

    (1997)
  • S. Ventura et al.

    Birthsfinal data for 1997

    Natl Vital Stat Rep

    (1999)
  • T. Mathews

    Smoking during pregnancy, 1990–96

    Natl Vital Stat Rep

    (1998)
  • L. Fingerhut et al.

    Smoking before, during and after pregnancy

    Am J Public Health

    (1990)
  • Office of Applied Studies

    Preliminary results from the 1996 National Household Survey on drug abuse

    (1997)
  • T. Mathews

    Smoking during pregnancy in the 1990s

    Natl Vital Stat Rep

    (2001)
  • L. Woodby et al.

    Predictors of smoking cessation during pregnancy

    Addiction

    (1999)
  • Cited by (116)

    • Correlates of continued cannabis use during pregnancy

      2021, Drug and Alcohol Dependence
      Citation Excerpt :

      Pregnancy and smoking characteristics, including not being primiparous (i.e., not pregnant for the first time) (Balázs et al., 2018; Míguez et al., 2017; Solomon and Quinn, 2004), having an unplanned pregnancy (Schneider et al., 2010; Solomon and Quinn, 2004), younger age of initiation of smoking (Coleman-Cowger et al., 2015; Wakschlag et al., 2002), and heavier smoking pre-pregnancy (Higgins et al., 2009; Míguez et al., 2017; White et al., 2014) have also been associated with continuing to smoke, as have higher levels of depression (Coleman-Cowger et al., 2015; Smedberg et al., 2015) and anxiety (Míguez et al., 2017). Lower perceived risk to the fetus also predicts continued smoking (Ockene et al., 2002; Smedberg et al., 2015). Last, delay discounting (DD), an index of impulsivity that measures the tendency to devalue delayed rewards that is positively related to cigarette smoking in general (Bickel et al., 2019; Kim-Spoon et al., 2019; VanderBroek et al., 2016), is also positively associated with continued smoking during pregnancy (White et al., 2014).

    • Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study

      2019, Women and Birth
      Citation Excerpt :

      For instance, pregnant women who used alcohol underestimated the risk of alcohol use (though, they overestimated the risk of caffeine37). Similarly, women were less likely to discontinue smoking when they reported a lower perceived risk to the fetus.38 The vulnerable women in the current sample may have low health literacy, which relates to decreased participation in prenatal care.36

    • Risk taking propensity in pregnancy — Longitudinal study

      2017, Personality and Individual Differences
    • Analysis of qualitative data from the investigation study in pregnancy of the ASSIST Version 3.0 (the Alcohol, Smoking and Substance Involvement Screening Test)

      2016, Midwifery
      Citation Excerpt :

      A recent study by Saitz and colleagues (Saitz et al., 2014) confirmed the value of single screening questions (so termed SSQs) for preliminary assessment of substance use; the findings with this cohort also suggest utilisation of a single question targeted to tobacco use [for example, adapted from Fagerstrom (Heatherton et al., 1991)] as a valuable first screening approach for this population. The motivation for women to cease use of substances when pregnant has been described elsewhere (Wakefield and Jones, 1998; Ockene et al., 2002); although demonstrated in this research, it was not universal. However, several women did report multiple unsuccessful attempts to stop substance use, especially use of tobacco, with one woman detailing unsuccessful use of several methods (‘patches, the QUIT line and cold turkey’) while another woman observed that she had been able to control use of other substances but not of tobacco.

    View all citing articles on Scopus
    View full text