Criminal institutions and social services: Are we missing opportunities to prevent smoking during pregnancy?

Objectives: Despite public health efforts, women continue to smoke during pregnancy. Although jails and prisons provide a unique opportunity for educating pre- and inter-conception women, the role of criminal history on smoking during pregnancy is not well investigated. This study examines the influence of criminal history on smoking during pregnancy among underserved black women. Methods: A cross-sectional survey was conducted at an outpatient obstetrics-gynecology clinic of an inner-city university hospital in Virginia from March 2009 through January 2011 in which pregnant women (N=902) were interviewed at their first prenatal care visit. Survey questions included items related to women's sociodemographic characteristics as well as their criminal history and current smoking status. Multiple logistic regression was conducted to calculate odds ratios and 95% confidence intervals depicting the relationship between criminal history and the likelihood that women reported current smoking. Results: The average age of the study participants was 24.8 (SD=5.9) years. More than two third reported having had a high school education or less, being unemployed, unmarried and receiving public insurance. Over 63% were participating in public assistance programs. Approximately 17% reported smoking the day of the interview and 19% reported criminal history. Criminal history was significantly associated with smoking during pregnancy (AOR = 2.6, 95% CI = 1.7 – 3.9). Conclusions: Criminal history is an important correlate of smoking during pregnancy. Prisons and rehabilitative programs for women involved in justice system can provide unique opportunities for education and cessation interventions during the preconception or interconception period.