Date on Master's Thesis/Doctoral Dissertation

5-2014

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Nursing

Degree Program

Nursing, PhD

Committee Chair

Hall, Lynne A

Committee Co-Chair (if applicable)

Ashford, Kristin

Committee Member

Ashford, Kristin

Committee Member

Polivka, Barbara

Committee Member

Ridner, S. Lee

Subject

Cigarette smokers--Economic conditions; Cigarette smokers--Social conditions; Pregnant women--Tobacco use

Abstract

The prevalence of prenatal smoking is highest among women from low socioeconomic status (SES) backgrounds. The adverse effects of smoking on pregnancy outcomes are widely known and current intervention efforts appear to have reached their maximum effectiveness. Improving interventions, particularly for those who are most vulnerable to this behavior demands a deeper and more contextualized understanding of contributing factors. The purpose of this dissertation was to explore factors that influence the relationship between SES and prenatal smoking. This was done in three ways: a critical review of literature on prenatal smoking in low SES women; an examination of the state of nicotine dependence measurement with a psychometric evaluation of three nicotine dependence measures; and a study testing psychosocial variables as mediators and moderators of the relationship between SES and prenatal smoking. The critical review of literature showed that the profile of the low SES prenatal smoker is similar to that of the broader prenatal smoking population. More contextualized characteristics included: unique sources of stress; living in a working class-neighborhood; higher rates of alcohol consumption, substance abuse, and physical abuse; and issues with access to care. In the next manuscript, the psychometric properties of the most commonly used measures of nicotine dependence in perinatal smoking studies -- the Fagerström Test for Nicotine Dependence and two of its derivatives - were examined. Of these three measures, the Heaviness of Smoking Index is the briefest and demonstrated strong predictive validity for behavioral and biomarker indices. Cotinine measurements by saliva or urine are recommended as a helpful way to validate self-reports. In the final manuscript, a data-based study of 371 pregnant women, six predictors of prenatal smoking status were identified: SES, secondhand smoke exposure, race, parity, chronic stressors, and depressive symptoms. Chronic stressors, the quality of the primary intimate relationship, and depressive symptoms were mediators of the relationship between SES and prenatal smoking. The findings of this dissertation support the widely held belief that prenatal smoking is a complex phenomenon. Truly effective prevention and intervention approaches must address relevant psychosocial factors and future research must consider the multifactorial and interrelated nature of factors that influence prenatal smoking behavior.

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