Low-income pregnant women need support to quit smoking, drinking

September 24, 2002

Social support is sometimes a vital missing ingredient for lower-income women who continue to smoke or use alcohol during pregnancy. Public health professionals and clinicians can play an important role in filling this gap, suggest the results of a new study.

"Realistic approaches to helping these women remain a challenge," says author Judith K. Ockene, Ph.D., M.Ed., a professor of medicine and chief of the Division of Preventive and Behavioral Medicine at the University of Massachusetts Medical School in Worcester. The study appears in the October issue of the American Journal of Preventive Medicine.

"The frequent contacts women have with health professionals during pregnancy may provide valuable opportunities to discuss alcohol and tobacco use and encourage behavior changes," she adds.

Smoking and alcohol use during pregnancy have been shown to pose health risks to the fetus. Smoking increases the risk of conditions such as premature birth, asthma, and sudden infant death syndrome, while alcohol use is a major cause of mental retardation. Using both alcohol and tobacco has a synergistic effect -- that is, each substance worsens the other's effects.

Many women are aware of these dangers; a national survey found that up to 40 percent of smokers quit when they became pregnant. But smoking and alcohol use during pregnancy still occur. More than 13 percent of mothers reported being smokers on 1996 Massachusetts birth certificates, according to the study.

The study by Ockene and her colleagues examined interviews with approximately 600 pregnant women who were either current smokers, or who had quit smoking when they discovered they were pregnant. All participants were Boston-area residents receiving prenatal care from a publicly funded Women, Infants and Children program. The women were ethnically and racially diverse, but most were born in the United States. Also, most were unmarried, and more than 40 percent of the women had less than a high school education.

The researchers found that, consistent with other research, study participants were far more likely to stop drinking alcohol (80 percent) than quit smoking cigarettes (27 percent) when they discovered they were pregnant.

This large difference between tobacco and alcohol behaviors may reflect the fact that "both substances are potentially addictive and women may not be likely to quit both at the same time," Ockene says. The researchers also noted that reports of alcohol cessation could have been exaggerated. The women received a breath test for cotinine, a component of nicotine, to confirm smoking cessation, but no test to confirm alcohol cessation.

Pregnant black women were found less likely than whites and Hispanics to quit smoking. This finding is inconsistent with previous studies and needs to be confirmed with additional studies, say the researchers.

Women who spontaneously stopped drinking alcohol when they found out they were pregnant were more likely to report that they had social support. Health professionals can help provide social support for women who may be receiving little support from their families and friends, according to the study.

Women who didn't quit smoking tended to be less educated. They also tended to be more addicted to nicotine, and have a partner who smoked. Also they had less awareness of the risk of smoking on the fetus, and commonly reported having too many other life problems to stop smoking.

Such women "portray an interesting constellation of addiction, life worries (including multiple children perhaps) and an environment that essentially reinforces continued smoking," Ockene says. Clinicians need to recognize that such women need support from several different angles.

"It is important for clinicians to be aware of and acknowledge the difficulties these women face, and to help them develop motivation and skills to engage their partners and support systems in their cessation attempts," she adds.
This study was supported by a grant from the National Heart, Lung and Blood Institute.

Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Contact Judith Ockene, Ph.D., at (508) 856-2316 or Judith.Ockene@umassmed.edu.
American Journal of Preventive Medicine: Contact the editorial office at (619) 594-7344.

Center for Advancing Health

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