Psychosocial differences between smokers and non-smokers during pregnancy

Despite the well-established adverse birth and childhood health outcomes associated with maternal smoking, smoking rates among pregnant women remain high. Psychosocial health attributes, including anxiety, depression, perceived stress, self-efficacy, and personality characteristics, have especially important roles in smoking behavior. Understanding who smokes during pregnancy and what factors influence this behavior choice may be key to improving the effectiveness of smoking cessation intervention programs. We use data from a prospective cohort study of pregnant women to understand the psychosocial health profiles of women who choose to smoke during pregnancy compared to the profiles of women who do not smoke or successfully quit smoking during pregnancy. Multinomial logistic regression analyses on 1518 non-Hispanic black and non-Hispanic white women assessed the association between smoking status and psychosocial health while controlling for demographic characteristics. Higher levels of perceived stress, depression, neuroticism, negative paternal support, and perceived racism among non-Hispanic blacks were associated with higher odds of being a smoker than a non-smoker (p < 0.05). Higher levels of self-efficacy, extraversion, agreeableness, conscientiousness, interpersonal support, positive paternal support, and perceived social standing were associated with lower odds of being a smoker than a non-smoker (p < 0.05). Our analysis indicates that women who smoked during pregnancy experienced a more negative constellation of psychosocial adversities than women who did not smoke. Given the psychosocial needs and personality profiles experienced by smokers, more attention to the psychosocial strengths and weaknesses of these women may allow for more tailored smoking cessation programs, enhancing both the short- and long-term effectiveness of such interventions.