Growth Models of Maternal Smoking Behavior: Individual and Contextual Factors

Abstract

Background Persistent maternal smoking during pregnancy, reduction or cessation during pregnancy, and smoking initiation or resumption postpartum impel further research to understand these behavioral patterns and opportunities for intervention. Objectives We investigated heterogeneous longitudinal patterns of smoking quantity to determine if these patterns vary across three maternal age groups, and whether the influence of individual and contextual risk factors varies by maternal age. Methods Separate general growth mixture models were estimated for mothers ages 15–25, 26–35, and 36+, allowing different empirical patterns of an ordinal measure of smoking behavior at six time points, from preconception through child entry to kindergarten. Results We identify five classes for mothers ages 15–25, four classes for ages 26–35, and three classes for ages 36+. Each age group presents classes of nonsmokers and persistent heavy smokers. Intermediate to these ends of the spectrum, each age group exhibited its own smoking classes characterized by the extent of pregnancy smoking reductions and postpartum behavior. In all three age groups, class membership can be distinguished by individual sociodemographic and behavioral characteristics. Co-resident smokers predicted nearly all smoking classifications across age groups, and selected neighborhood characteristics predicted classification of younger (15–25) and older (36+) mothers. Conclusions The design, timing, and delivery of smoking prevention and cessation services, for women seeking to become pregnant and for women presenting for prenatal or pediatric care, are best guided by individual characteristics, particularly maternal age, preconception alcohol consumption, and postpartum depression, but neighborhood characteristics merit further attention for mothers at different ages.

Concurrent Trajectories of Female Drinking and Smoking Behaviors Throughout Transitions to Pregnancy and Early Parenthood

“…Results are largely consistent with the literature regarding the effect of maternal age at childbirth (Meschke et al, 2013); education (Laborde & Mair, 2012); marital status (Tsai et al, 2010); income (Jagodzinski & Fleming, 2007); employment (Mumford & Liu, 2015); postpartum depression (Munafo, Heron, & Araya, 2008); and breastfeeding (Jagodzinski & Fleming, 2007). This study adds to the literature by examining how maternal smoking and drinking fluctuate concurrently in concert with the context of demographic and behavioral correlates.…”

“…Despite a concerning level of concurrent use during the perinatal period and shared risk factors, e.g., mental disorders (Ingersoll, Hettema, Cropsey, & Jackson, 2011), being unmarried (Tsai, et al, 2010), curtailed breastfeeding (Jagodzinski & Fleming 2007), longitudinal patterns of maternal smoking (Mumford & Liu 2015) and drinking (Liu, Mumford, & Petras, 2015) have only been modeled separately. To inform public health and clinical efforts in better allocating prevention efforts, we investigate distinct trajectories representing single and dual usage of alcohol and cigarettes by mothers from pre-conception through the early parenting years, and the extent to which mothers’ baseline characteristics are associated with these patterns.…”

Maternal trajectories of cigarette use as a function of maternal age and race

“…Compared to the African-American mothers, more of the White mothers were classified in the chronic smoker trajectory (52% vs. 32%) and fewer were in the non-smoker trajectory (29% vs. 34%), consistent with previous findings among men (White et al, 2004). In the Early Childhood Longitudinal Study (ECLS-B), White mothers were also more likely than African-American mothers to be in one of the smoking trajectories rather than in the non-smoking class, regardless of their age (Mumford & Liu, 2015). …”

“…White et al (2004) found more African-American males in the non-smoker group, and more White males in the chronic smoker group. Similarly, there were more White mothers in the smoking trajectories and more African-American mothers in the non-smoking trajectory in the Early Childhood Longitudinal Study (ECLS-B: Mumford et al, 2014; 2015). There may also be an interaction or —crossover effect for race and age: White adolescents are more likely to smoke, but African-Americans who smoke are less likely to desist in adulthood (Evans-Polce et al, 2015; Geronimus et al, 1993; Kandel et al, 2011; Lawrence et al, 2014; Yuan, 2011).…”

“…However, for adolescents, pregnancy is associated with smoking (Ellickson et al, 2001; Graham et al, 2010; McGee & Williams, 2006; Tucker et al, 2006) and teen mothers have higher rates of perinatal smoking than older women (Cornelius et al, 1994; De Genna et al, 2009; Graham et al, 2010). Only two prior studies have examined the role of maternal age in patterns of smoking over time, finding more smoking overall and more heterogeneity in patterns of smoking among the younger mothers (Mumford & Liu, 2015; Tucker et al, 2006). …”