Pregnancy smoking in context: the influence of multiple levels of stress.

Pregnancy smoking remains a major public health concern in the United States. Approximately 10.2% of women smoke during pregnancy, placing their offspring at increased risk for adverse perinatal and childhood outcomes. However, little is known about contextual influences on pregnancy smoking. This study examines the intimate social context, broader social context, and socioeconomic context as predictors of smoking in a sample of 113 pregnant women (M (age) = 29.7 years; 90.3% White, non-Hispanic). We developed latent variables at each contextual level comprising indicators of stress and resources measured during the first and second trimesters, to serve as predictors of both persistent pregnancy smoking and smoking intensity during the third trimester in a single comprehensive structural equation model. Results indicate that stressful socioeconomic context was positively associated with the probability of being a persistent pregnancy smoker (probit regression coefficient = .70, p<.05). Broader social context was the only significant predictor of smoking rate, with greater stress and fewer resources associated with a greater number of cigarettes smoked during the third trimester (standardized regression coefficient = .81, p<.05). Results suggest that pregnancy smoking is a complex phenomenon that may be influenced by psychosocial context at multiple levels. Elucidating mechanisms by which contextual influences affect pregnant women's smoking patterns may inform smoking cessation and reduction interventions with this population.