Psychosocial differences between smokers and non-smokers during pregnancy

Psychosocial factors are associated with a person's likelihood of smoking. Further, women who smoke during pregnancy are more likely to have low birthweight infants, making it essential to understand psychosocial disparities between pregnant smokers and non-smokers. Pregnant women (n=866, 69% Non-Hispanic Black, 18% Non-Hispanic White, 7% Hispanic, 4% Asian, and <1% other/unknown race) were enrolled in an observational prospective pregnancy cohort study. They completed surveys about socioeconomic status, social support, self-efficacy, perceived stress, depression, racism, and personality at pre-natal visits. Smoking status and medical histories were collected from electronic medical charts. Percentages of non-smokers, smokers, and reported quitters were 71%, 21%, and 8%, respectively. Smokers were significantly more likely than non-smokers to be unmarried, make less than $20,000/year, and have high school or lower educational attainment. On personality domains, smokers scored significantly higher than non-smokers on neuroticism but lower on extraversion, openness, agreeableness and conscientiousness. Smokers had significantly higher depression and perceived stress scores, and less support (social and paternal) and self-efficacy than non-smokers. Smokers had significantly lower birthweight infants than non-smokers, but not a significant difference in gestational age at delivery. There was no relationship between smoking and race, and no significant differences between smokers and non-smokers on John Henryism or racism. Psychosocial differences between smokers and non-smokers highlight the importance of addressing maternal psychosocial health when designing public health interventions for smoking cessation, especially given the importance of smoking status to successful pregnancy outcomes.