Stress, depression, and smoking cessation among pregnant women with Medicaid insurance

Objective Smoking during pregnancy is the single most modifiable risk factor of poor birth outcomes in the United States. We examine the associations between smoking status, depression, and stress in a sample of Medicaid-eligible pregnant women.

Materials and Methods We surveyed pregnant women when screened for enhanced prenatal services. If a woman self-reported as a smoker, a series of additional questions documented the amount she smokes, and nicotine dependence. Stress, depressive history, and current depressive symptoms were the explanatory variables of main interest. Other factors considered included health behaviors, demographics, and pregnancy related factors. We present descriptive statistics and use logistic regression analysis to identify independent effect of each factor considered.

Key findings First we compared continuous smokers to quitters during pregnancy. Depression history, current depressive symptoms, and stress were each highly predictive of smoking when considered independently. Including all three variables and other covariates in a multivariate regression, depressive symptoms remained highly associated with smoking: moderately depressed women had 2.36 the smoking odds of women who were not depressed. When comparing continuous smokers to non-smokers in a multivariate regression, current depressive symptoms and stress are associated with smoking. The odds of smoking of severely depressed women are 1.49 the odds of women with no depressive symptoms, and the odds of women with high stress scores are 1.64 the odds of other women.

Conclusion Current depressive symptoms and stress are associated with continuous smoking during pregnancy. Policy initiatives aimed at reducing depression and stress may decrease the smoking prevalence.