Skip to main content
NCBI home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1996 Feb;50(1):33–39. doi: 10.1136/jech.50.1.33

Psychosocial resources and persistent smoking in early pregnancy--a population study of women in their first pregnancy in Sweden.

E Dejin-Karlsson 1, B S Hanson 1, P O Ostergren 1, J Ranstam 1, S O Isacsson 1, N O Sjöberg 1
PMCID: PMC1060201  PMID: 8762351

Abstract

STUDY OBJECTIVE: To test the stress hypothesis by characterising women during their first pregnancy who continue to smoke in early pregnancy in comparison with women who quit smoking, with special reference to psychosocial factors like social network, social support, demands, and control in work and daily life. DESIGN: The study is based on a cohort of primigravidas followed during pregnancy. Data were collected by self administered questionnaires during the pregnant womens' first antenatal visit at about 12 weeks. SETTING: The study was performed in the antenatal clinics in the city of Malmö, Sweden. PARTICIPANTS: The participants were all primigravidas living in the city of Malmö, Sweden, over a one year period, 1991-92. A total of 872 (87.7%) of the 994 invited women agreed to participate. The population of this study on smoking includes all primigravidas who at the time of conception were smoking (n = 404, 46.3%). MAIN RESULTS: At the first antenatal visit (63.6% (n = 257) of the prepregnancy smokers were still smoking (a total smoking prevalence of 29.5%). The pregnant smokers were on average younger and had a lower educational level. The highest relative risk (RR) of continued smoking was found among unmarried women RR 2.7 (95% confidence interval) (1.5, 4.8), women having unplanned pregnancies RR 2.2 (1.2, 4.0) and those with a low social participation RR 1.6 (1.0, 2.7), low instrumental support RR 2.6 (1.2, 6.0), low support from the child's father RR 2.1 (1.0, 4.2) and those exposed to job strain RR = 2.3 (1.1, 4.8). The associations were independent of potential confounders such as age, educational level, nationality, cohabiting status, passive smoking, and previous years of smoking. CONCLUSIONS: This study supports the stress hypothesis. Smoking can be one way women handle stress when demands become too great. In order to reduce smoking among pregnant women, maternity centre resources need to be focused more on women with low psychosocial resources who are at highest risk for continued smoking. It is also important to involve actively the woman's partner or other important people in the woman's social network.

Full text

PDF
33

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahlsten G., Cnattingius S., Lindmark G. Cessation of smoking during pregnancy improves foetal growth and reduces infant morbidity in the neonatal period. A population-based prospective study. Acta Paediatr. 1993 Feb;82(2):177–181. doi: 10.1111/j.1651-2227.1993.tb12634.x. [DOI] [PubMed] [Google Scholar]
  2. Backe B. Maternal smoking and age. Effect on birthweight and risk for small-for-gestational age births. Acta Obstet Gynecol Scand. 1993 Apr;72(3):172–176. doi: 10.3109/00016349309013367. [DOI] [PubMed] [Google Scholar]
  3. Brooke O. G., Anderson H. R., Bland J. M., Peacock J. L., Stewart C. M. Effects on birth weight of smoking, alcohol, caffeine, socioeconomic factors, and psychosocial stress. BMJ. 1989 Mar 25;298(6676):795–801. doi: 10.1136/bmj.298.6676.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cnattingius S., Haglund B., Meirik O. Cigarette smoking as risk factor for late fetal and early neonatal death. BMJ. 1988 Jul 23;297(6643):258–261. doi: 10.1136/bmj.297.6643.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cnattingius S., Lindmark G., Meirik O. Who continues to smoke while pregnant? J Epidemiol Community Health. 1992 Jun;46(3):218–221. doi: 10.1136/jech.46.3.218. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cnattingius S., Thorslund M. Smoking behaviour among pregnant women prior to antenatal care registration. Soc Sci Med. 1990;31(11):1271–1275. doi: 10.1016/0277-9536(90)90135-f. [DOI] [PubMed] [Google Scholar]
  7. Cohen S., Lichtenstein E. Partner behaviors that support quitting smoking. J Consult Clin Psychol. 1990 Jun;58(3):304–309. doi: 10.1037//0022-006x.58.3.304. [DOI] [PubMed] [Google Scholar]
  8. Coppotelli H. C., Orleans C. T. Partner support and other determinants of smoking cessation maintenance among women. J Consult Clin Psychol. 1985 Aug;53(4):455–460. doi: 10.1037//0022-006x.53.4.455. [DOI] [PubMed] [Google Scholar]
  9. Coste J., Job-Spira N., Fernandez H. Increased risk of ectopic pregnancy with maternal cigarette smoking. Am J Public Health. 1991 Feb;81(2):199–201. doi: 10.2105/ajph.81.2.199. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ericson A., Gunnarskog J., Källén B., Otterblad-Olausson P. Surveillance of smoking during pregnancy in Sweden, 1983-1987. Acta Obstet Gynecol Scand. 1991;70(2):111–117. doi: 10.3109/00016349109006191. [DOI] [PubMed] [Google Scholar]
  11. Fingerhut L. A., Kleinman J. C., Kendrick J. S. Smoking before, during, and after pregnancy. Am J Public Health. 1990 May;80(5):541–544. doi: 10.2105/ajph.80.5.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gjerdingen D. K., Froberg D. G., Fontaine P. The effects of social support on women's health during pregnancy, labor and delivery, and the postpartum period. Fam Med. 1991 Jul;23(5):370–375. [PubMed] [Google Scholar]
  13. Graham H. Women's smoking and family health. Soc Sci Med. 1987;25(1):47–56. doi: 10.1016/0277-9536(87)90206-1. [DOI] [PubMed] [Google Scholar]
  14. Haglund B., Cnattingius S. Cigarette smoking as a risk factor for sudden infant death syndrome: a population-based study. Am J Public Health. 1990 Jan;80(1):29–32. doi: 10.2105/ajph.80.1.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Haire-Joshu D., Morgan G., Fisher E. B., Jr Determinants of cigarette smoking. Clin Chest Med. 1991 Dec;12(4):711–725. [PubMed] [Google Scholar]
  16. Hanson B. S., Isacsson S. O., Janzon L., Lindell S. E. Social support and quitting smoking for good. Is there an association? Results from the population study, "Men born in 1914," Malmö, Sweden. Addict Behav. 1990;15(3):221–233. doi: 10.1016/0306-4603(90)90065-6. [DOI] [PubMed] [Google Scholar]
  17. Hanson B. S., Ostergren P. O. Different social network and social support characteristics, nervous problems and insomnia: theoretical and methodological aspects on some results from the population study 'men born in 1914', Malmö, Sweden. Soc Sci Med. 1987;25(7):849–859. doi: 10.1016/0277-9536(87)90043-8. [DOI] [PubMed] [Google Scholar]
  18. Hanson B. S. Social network, social support and heavy drinking in elderly men--a population study of men born in 1914, Malmö, Sweden. Addiction. 1994 Jun;89(6):725–732. doi: 10.1111/j.1360-0443.1994.tb00958.x. [DOI] [PubMed] [Google Scholar]
  19. Haug K., Aarø L. E., Fugelli P. Smoking habits in early pregnancy and attitudes towards smoking cessation among pregnant women and their partners. Fam Pract. 1992 Dec;9(4):494–499. doi: 10.1093/fampra/9.4.494. [DOI] [PubMed] [Google Scholar]
  20. Homer C. J., James S. A., Siegel E. Work-related psychosocial stress and risk of preterm, low birthweight delivery. Am J Public Health. 1990 Feb;80(2):173–177. doi: 10.2105/ajph.80.2.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Lindmark G., Cnattingius S. The scientific basis of antenatal care. Report from a state-of-the-art conference. Acta Obstet Gynecol Scand. 1991;70(2):105–109. doi: 10.3109/00016349109006190. [DOI] [PubMed] [Google Scholar]
  22. Maclaine K., Clark J. M. Women's reasons for smoking in pregnancy. 1991 May 29-Jun 4Nurs Times. 87(22):39–42. [PubMed] [Google Scholar]
  23. Oakley A. Who cares for health? Social relations, gender, and the public health. Duncan Memorial Lecture. J Epidemiol Community Health. 1994 Oct;48(5):427–434. doi: 10.1136/jech.48.5.427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Ockene J. K., Benfari R. C., Nuttall R. L., Hurwitz I., Ockene I. S. Relationship of psychosocial factors to smoking behavior change in an intervention program. Prev Med. 1982 Jan;11(1):13–28. doi: 10.1016/0091-7435(82)90002-0. [DOI] [PubMed] [Google Scholar]
  25. Ockene J. K., Nutall R., Benfari R. C., Hurwitz I., Ockene I. S. A psychosocial model of smoking cessation and maintenance of cessation. Prev Med. 1981 Sep;10(5):623–638. doi: 10.1016/0091-7435(81)90052-9. [DOI] [PubMed] [Google Scholar]
  26. Olsen J. Predictors of smoking cessation in pregnancy. Scand J Soc Med. 1993 Sep;21(3):197–202. doi: 10.1177/140349489302100309. [DOI] [PubMed] [Google Scholar]
  27. Patrick D. L., Cheadle A., Thompson D. C., Diehr P., Koepsell T., Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994 Jul;84(7):1086–1093. doi: 10.2105/ajph.84.7.1086. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Pritchard C. W. Depression and smoking in pregnancy in Scotland. J Epidemiol Community Health. 1994 Aug;48(4):377–382. doi: 10.1136/jech.48.4.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Quinn V. P., Mullen P. D., Ershoff D. H. Women who stop smoking spontaneously prior to prenatal care and predictors of relapse before delivery. Addict Behav. 1991;16(1-2):29–40. doi: 10.1016/0306-4603(91)90037-i. [DOI] [PubMed] [Google Scholar]
  30. Rutter D. R., Quine L. Inequalities in pregnancy outcome: a review of psychosocial and behavioural mediators. Soc Sci Med. 1990;30(5):553–568. doi: 10.1016/0277-9536(90)90154-k. [DOI] [PubMed] [Google Scholar]
  31. Schachter S., Silverstein B., Kozlowski L. T., Perlick D., Herman C. P., Liebling B. Studies of the interaction of psychological and pharmacological determinants of smoking. J Exp Psychol Gen. 1977 Mar;106(1):3–12. doi: 10.1037/h0078126. [DOI] [PubMed] [Google Scholar]
  32. Sexton M., Fox N. L., Hebel J. R. Prenatal exposure to tobacco: II. Effects on cognitive functioning at age three. Int J Epidemiol. 1990 Mar;19(1):72–77. doi: 10.1093/ije/19.1.72. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES