Psychosocial and Spiritual Factors Associated With Smoking and Substance Use During Pregnancy in African American and White Low-Income Women

doi:10.1111/j.1552-6909.2006.00010.x

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 35, Issue 1, January–February 2006, Pages 68-77

https://doi.org/10.1111/j.1552-6909.2006.00010.x Get rights and content

Objective

To determine the associations between sociodemographic, psychosocial, and spiritual factors to health risk behaviors during pregnancy in African American and White low-income women.

Design

Descriptive, using prenatal interviews and medical record review as data sources.

Setting

An urban prenatal clinic in the Midwestern United States.

Participants

One hundred thirty ethnically diverse low-income women.

Main Outcome Measures

Smoking and substance use in pregnancy.

Results

For the total sample, 39% reported smoking and 28% reported substance use in pregnancy. Significant predictors of smoking were White race, less than high school education, abuse, and religiosity. Abuse and depressive symptoms predicted substance use. African American women were significantly less likely to report smoking in pregnancy (28%) than were White women (55%) (p < .05). African American women who smoked during pregnancy were significantly more likely to report lower levels of education (p < .01), less social support from others (p < .01) and total social support (p < .01), higher levels of stress (p < .05), and more frequent substance use (56.5%) than African American women who did not smoke (12%) (p < .001). White women who used substances were significantly more likely to report smoking (p < .01), abuse (p < .05), and a history of delivering a preterm or low-birthweight infant (p < .01) than the White women who did not.

Conclusion

Integrating social support and stress-relieving activities in smoking cessation interventions, particularly for African American women, may reduce health risk behaviors, eliminate health disparities, and improve maternal and infant quality of life. JOGNN, 35, 68-77; 2006. DOI: 10.1111/J.1552-6909.2006.00010.x

Section snippets

Risks and moderators associated with smoking and substance use

Smoking and substance use in pregnancy are associated with higher psychosocial risks as either consequences or precursors of the behavioral risks. Copper et al. (1996) (n= 2593) reported that women with higher levels of stress, and depression, and lower levels of self-esteem reported significantly more smoking and use of drugs and alcohol. Women who report physical or sexual abuse are significantly more likely to report substance abuse in pregnancy (Curry et al., 1998, Horrigan et al., 2000);

Study measures

Data were collected on sociodemographic factors (racial/ethnic group, insurance status, and level of education), and history of preterm birth was obtained from prenatal records. Information on health risk behaviors was obtained from the respondents’ self-report and from the labor and delivery medical admission records. Psychosocial risks were defined as symptoms of depression, current level of stress, and physical abuse during pregnancy, within the last year, or both. Resources were defined as

Setting and sample

This study was part of a larger study, which has been reported elsewhere (Jesse, Walcott-McQuigg, Mariella). The convenience sample of 130 African American and White low-income women was recruited from an urban prenatal clinic in the Midwest. Women were included if they were English speaking, between 14 to 44 years of age, at a gestational age of 16 to 28 weeks, and with a singleton pregnancy. Women were excluded if they had cognitive disability, had a spontaneous abortion before 20 weeks of

Results

The majority of the women in the study were African American (62%), partnered (58%), and with a high school education (65%), reflecting the demographics of the urban Midwestern clinic site. The average age was 24 years (range 15-44), but 12% were adolescents (aged 16-19 years). The majority was receiving Medicaid (75%) or another form of public health insurance (1.5%). Other women had a blend of public and private health care insurance (14%) or were uninsured (9%). Seventy-eight percent were

Discussion

This study examined psychosocial risks and psychosocial and spiritual resources associated with smoking and substance use in pregnancy among African American and White low-income women. There was a strong link between women's smoking and use of drugs and alcohol in pregnancy. African American women's risk of substance use in this study was more than four times higher if they smoked in pregnancy than if they did not. Similar to the findings reported by Svikis et al. (1997), all women who

Limitations

Although this sample was ethnically diverse, participation was limited to African American and White women who spoke English. The association between smoking and substance use and psychosocial risks and resources reported here cannot be inferred as a casual relationship. There are always limitations with self-report of smoking and substance use in pregnancy because women often underreport.

Conclusion

If health care providers know the bio-psychosocial-spiritual characteristics of African American and White women who are likely to smoke and use substances and the characteristics of those who are not early during pregnancy or preconception, they could tailor interventions. As the result of the findings from this study, it is important to integrate social support and stress-relieving activities into smoking cessation programs, particularly for African American women and to recognize and address

Acknowledgments

Funded by Sigma Theta Tau Delta Omicron and the Purdue University School of Nursing Research Funds.

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We use data from the U.S. Fragile Families and Child Wellbeing study to test whether maternal religious attendance is protective against low birth weight. Building on previous research, we also consider the mediating influence of mental health, cigarette use, alcohol use, illicit drug use, poor nutrition, and prenatal care. Our results indicate that maternal religious attendance is protective against low birth weight. In fact, each unit increase in the frequency of religious attendance reduces the odds of low birth weight by 15%. Religious attendance is also associated with lower odds of cigarette use and poor nutrition, but is unrelated to mental health, alcohol use, illicit drug use, and prenatal care. Although lower rates of cigarette use help to mediate or explain 11% of the association between maternal religious attendance and low birth weight, we find no evidence to substantiate the mediating influence of mental health, alcohol use, illicit drug use, poor nutrition, or prenatal care. Our results suggest that the health benefits of religious involvement may extend across generations (from mother to child); however, additional research is needed to fully explain the association between maternal religious attendance and low birth weight. It is also important for future research to consider the extent to which the apparent health advantages of religious adults might be attributed to health advantages in early life, especially those related to healthy birth weight.
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These factors may also extend to knowledge about the effects of smoking on fetal development, as a recent study found that AAW with lower levels of education were also more likely to report smoking during pregnancy. Among AAW, 47.8% of smokers had less than a high school education and 15.5% of non-smokers had less than a high school education in this study (maybe added in a statistic regarding the percent of AAW with lower levels who are pregnant) (Elizabeth Jesse et al., 2006). The association between education and smoking among pregnant women highlights a critical need for further investigation and further complicates the picture.
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CLINICAL RESEARCHPsychosocial and Spiritual Factors Associated With Smoking and Substance Use During Pregnancy in African American and White Low-Income Women

Objective

Design

Setting

Participants

Main Outcome Measures

Results

Conclusion

Section snippets

Risks and moderators associated with smoking and substance use

Study measures

Setting and sample

Results

Discussion

Limitations

Conclusion

Acknowledgments

Addictive Behavior

Journal of Obstetric, Gynecologic, & Neonatal Nursing

Seminars in Neonatology

Am J Prev Med

Drug and Alcohol Dependence

American Journal Obstetrics and Gynecology

J Obstet Gynecol Neonatal Nurs

Journal of Substance Abuse Treatment

Journal of Obstetric, Gynecologic, & Neonatal Nursing

Journal of Midwifery and Women's Health

Obstetrics and Gynecology

Journal of the Society of Obstetrics & Gynecology of Canada

Social Science and Medicine

Preventive Medicine

American Journal of Preventive Medicine

Journal of Obstetric, Gynecologic, & Neonatal Nursing

Journal of Obstetric, Gynecolgic, and Neonatal Nursing

Journal Clinical Epidemiology

Menthol pharmacology and its potential impact on cigarette smoking behavior

Nicotine & Tobacco Research

Factors influencing cotinine half-life during smoking abstinence in African American and White women

Nicotine & Tobacco Research

Substance abuse in pregnancy

Int J Gynaecol Obstet

Committee Opinion. Smoking cessation during pregnancy

Obstetrics & Gynecology

Smoking 101 fact sheet

Beck Depression Inventory II manual

Racial and ethnic differences in serum cotinine levels of cigarette smokers: Third national health and nutrition examination survey, 1988-1991

JAMA

Cigarette smoking among adults—United States, 2000

Morbidity and Mortality Weekly Report

Smoking during pregnancy—United States, 1990-2002

Morbidity and Mortality Weekly Report

Smoking During Pregnancy – U.S., 1990-2002

Morbidity and Mortality Weekly Report

A brief screening instrument for problem drinking in the emergency room: The RAPS4. Rapid alcohol problems screen

Journal of Studies of Alcohol

The effect of implementing a more comprehensive screening for substance use among pregnant women in North Carolina

South Dakota Journal of Medicine

CLINICAL RESEARCH
Psychosocial and Spiritual Factors Associated With Smoking and Substance Use During Pregnancy in African American and White Low-Income Women