Psychosocial and spiritual factors associated with smoking and substance use during pregnancy in African American and White low-income women.

OBJECTIVE: To determine the associations between sociodemographic, psychosocial, and spiritual factors to health risk behaviors during pregnancy in African American and White low-income women.

DESIGN: Descriptive, using prenatal interviews and medical record review as data sources.

SETTING: An urban prenatal clinic in the Midwestern United States.

PARTICIPANTS: One hundred thirty ethnically diverse low-income women.

MAIN OUTCOME MEASURES: Smoking and substance use in pregnancy.

RESULTS: For the total sample, 39% reported smoking and 28% reported substance use in pregnancy. Significant predictors of smoking were White race, less than high school education, abuse, and religiosity. Abuse and depressive symptoms predicted substance use. African American women were significantly less likely to report smoking in pregnancy (28%) than were White women (55%) (p < .05). African American women who smoked during pregnancy were significantly more likely to report lower levels of education (p < .01), less social support from others (p < .01) and total social support (p < .01), higher levels of stress (p < .05), and more frequent substance use (56.5%) than African American women who did not smoke (12%) (p < .001). White women who used substances were significantly more likely to report smoking (p < .01), abuse (p < .05), and a history of delivering a preterm or low-birthweight infant (p < .01) than the White women who did not.

CONCLUSION: Integrating social support and stress-relieving activities in smoking cessation interventions, particularly for African American women, may reduce health risk behaviors, eliminate health disparities, and improve maternal and infant quality of life.