Stress, Self-Esteem, and Pregnant Smokers

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Over 30% of women in Northeast Tennessee smoke during pregnancy. Understanding how psychosocial variables relate to smoking status and amount is important for cessation interventions. During pregnancy, this information is even more imperative, as the well-being of the developing child is also at risk. Stress, self-esteem, and smoking have the potential to be modified during pregnancy to improve pre- and postnatal health outcomes for the mother and child. Stress levels have been clearly linked to smoking habits; however, the research on self-esteem and smoking habits has been mixed. The purpose of the current study was to analyze stress and self-esteem in pregnancy, and to examine how they are both related to smoking status. Data were analyzed using questionnaire responses acquired from 581 TIPS (Tennessee Intervention for Pregnant Smokers) participants during their first trimester. TIPS is a state funded project which enrolls smokers and nonsmokers. Participants met with a case manager at their prenatal care provider, and completed a packet of questionnaires which included the Prenatal Psychosocial Profile (PPP), and several questions inquiring about their past and current smoking status. The participants were paid $20 for each research meeting. The PPP instrument is a composite measure of stress, self-esteem and social support. Both stress t (485.27) = -6.01, p < 0.001, and self-esteem t (573) = 5.60, p < 0.001 measures were significantly different for smokers and non-smokers As predicted, stress levels were higher and self-esteem levels were lower in pregnant smokers compared to non-smokers. The full direct logistic regression model predicting smoking status based on stress and self-esteem, controlling for age and marital status was significant, χ2 (2, n = 575) = 35.02, p < .001. Stress, self-esteem, and marital status all made significant contributions to the model. Because both stress and self-esteem levels were related to smoking status during pregnancy, efforts to change stress and self-esteem levels in pregnancy should be investigated as a possible aid to smoking cessation efforts. Future research should also investigate how stress and self-esteem levels may change over time throughout pregnancy and how that may affect birth outcomes, such as low birth weight or premature delivery.


Johnson City, TN

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