Date of Award
Doctor of Philosophy (PhD)
Population-level trends on sociodemographic risk factors for cigarette smoking during pregnancy (SDP) and outcomes for offspring exposed to maternal SDP are well established. However, the more complex task of understanding individual risk-prediction, including differences by maternal race/ethnicity, and its clinical application, remains incomplete. Characterizing the relative influence of environmental and individual characteristics as risk or protective factors for continued SDP is a necessary next step for informing individual- and public health-level interventions to produce successful smoking cessation prior to pregnancy, substantially reducing smoking-related mortality in child-bearing people. In this dissertation, I wanted to explore how multiple levels of influence, from individual, to family, to neighborhood, interact to confer risk or protection for SDP.
First, I used a population-level birth cohort from state birth records of first births including geocoded maternal address at time of childbirth to compare individual and neighborhood level sociodemographics as risk and protective influences for SDP. I found important social influences on cigarette smoking during first pregnancy—marital status, reproductive partner acknowledgement of paternity, and census tract-level SDP rate. Moreover, there were differences in risk factors by maternal race/ethnicity, in particular, among Black/African Americans, where SDP was higher in tracts with a greater proportion of white non-Hispanic residents.
To examine how clinical factors, namely nicotine dependence, modulate risk for SDP, I used research data from a well-characterized like-sex female twin pair sample, connected to birth records for children born to the twin participants. I found that lifetime heaviness of nicotine dependence contributed as much risk to SDP as maternal sociodemographics at time of childbirth; however, the contribution of nicotine dependence to SDP risk was diminished at high levels of sociodemographic risk. These findings were limited to white non-Hispanic participants, as there was insufficient sample size from Black/African American participants.
Finally, I wanted to use findings from administrative data to inform research design and address the needs of historically excluded populations, considering protective as well as risk factors. I wanted to identify protective factors for SDP among women who identify as American Indian or Alaska Native, as most existing research either excludes Native women, or only identifies higher rates of smoking, including SDP, without considering risk and protective factors. I conducted a pilot data collection from ten women recruited from birth records to examine the roles of positive racial identity, engagement with traditional tobacco use, and social influence by reproductive partner and cohabitants during pregnancy that might be associated with SDP. While I did not achieve a sufficient sample size for statistical analysis, I identified ways future work could explore these questions, including by working with a specific Tribe or Nation to address their questions about pregnancy and perinatal health and/or partnering with Tribal Epidemiology Centers to improve recruitment opportunities.
Chair and Committee
Andrew C. Heath Kathleen Bucholz
Arpana Agrawal, Alison G. Cahill, Patricia A. Cavazos-Rehg, John N. Constantino,
Houston-Ludlam, Alexandra Noel, "Individual and Social Influences on Cigarette Smoking During Pregnancy" (2023). Arts & Sciences Electronic Theses and Dissertations. 2858.