Assessment of Cigarette Smoking During Pregnancy: the Use of Behavioral Observation And

ASSESSMENT OF CIGARETTE SMOKING DURING PREGNANCY: THE USE OF BEHAVIORAL OBSERVATION AND FACTORS THAT PREDICT DENIAL

Beth A. Bailey, PhD, and Heather N. Wright, BS

EastTennesseeStateUniversity

Johnson City, TN

Background: Rates of pregnancy smoking remain high, and attempts to effectively intervene are hampered by failure to identify pregnant smokers as many deny smoking. Biochemical assessment is often impractical, and clear cut-offs to distinguish pregnant smokers from those exposed to ETS are not well established.Objective: The first goal was to determine the degree of pregnancy smoking denial compared with behavioral observation in a population with a high rate of pregnancy smoking. The second was to identify factors that predict denial in this population.Methods: Data from all women who gave birth in a rural county in Southern Appalachiaover2 years were obtained by chart review. Self-report of smoking status both throughout pregnancy and at delivery, and behavioral observation of smoking during the 3-5 day delivery hospitalization were recorded. Other data included sociodemographics and medical/lifestyle factors.Results: Based on behavioral observation, 42% of the 843 women were smokers. 8.2% of smokers denied smoking at hospital admission, while 16.2% denied throughout prenatal care. All who admitted smoking were observed smoking. Compared with those who admitted smoking, deniers were 3 times as likely to have education past high school. Theywere twice as likely to have private insurance, adequate prenatal care utilization, and to have no other children. They were 50% less likely to have biologic confirmation of illicit drug use, sexually transmitted diseases or hepatitis C. Additionally, teens denied more often than older women.Conclusions: Behavioral observation was a useful tool for assessing smoking status. Even in a culture with high rates of pregnancy smoking, 1 in 6 smokers denied this behavior during prenatal care. With the exception of teens, pregnant women most likely to deny smoking were those typically regarded as at lower risk of engaging in negative health behaviors by providers, increasing the chance that they would go undetected as smokers. Findings are a reminder to practitioners there is no reliable “high risk” profile of a smoking denier, and they should be diligent in identifying and addressing smoking with all pregnant patients.

Submitted to SRNT on 9/15/08 for presentation consideration at the 4/09 Dublin Meeting

Topic: Public Health

Keywords: Smoking Behavior, Risk Factors