Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Linda Alexander, EdD

Committee Member

Kate Eddens, PhD

Committee Member

Corrine Williams


Objective: To examine the association between stressful life events during pregnancy and change of maternal smoking behaviors.

Methods: We used data from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) to conduct the research. Our data included 24 states from 2011-2012. We considered 13 stressful life events and grouped them into four categories: emotional, partner-related, financial and traumatic stressors. Change of Maternal Smoking during pregnancy was defined by smoking at the last trimester of pregnancy versus smoking at 3 months prior to smoking. Confounders included maternal age, race/ethnicity, education, marital status, Medicaid coverage upon delivery and income prior to pregnancy.

Results: Financial stress was the most commonly reported stress during pregnancy (50.6%). Emotional stress is not significantly associated with change of maternal smoking after adjusting for confounders. Financial stress and traumatic-related stress were strongly associated with continued smoking. More specifically, mom couldn’t pay bills (1.321, CI: 1.169-1.493), husband/partner in jail (1.549, CI: 1.283-1.87) and someone close to mom having issues with drugs/alcohol (1.288, CI: 1.132-1.466) are strongly associated with continued smoking with decrease amount of cigarettes. Husband/partner lost jobs (1.22, CI: 1.028-1.447) and mom became homeless (1.429, CI: 1.115-1.83) are strong indicators of continued smoking at same/increased amount.

Conclusion: Significant associations exist between financial and traumatic stressors and continued smoking. Individual stressful event during pregnancy that is associated with continued smoking is identified and advised to be incorporated into psychosocial screening tools.

Included in

Public Health Commons