Tobacco is the single most modifiable cause of poor pregnancy outcomes [Centers for Disease Control (CDC), 2004a)]. There is no debate that smoking during pregnancy places pregnant women at greater risk for several adverse pregnancy outcomes including delivering a premature or low birthweight infant (CDC, 2004a). However, research linking prenatal secondhand smoke (SHS) exposure in nonsmoking women to adverse birth outcomes is limited. In 2006, the U.S. Surgeon General reported that there is no safe level of SHS exposure, and in fact, SHS exposure causes premature death in infants and adults (United States Department of Health and Human Services [USDHHS], 2006).
The purposes of this dissertation were to: (1) explore the perceived ways in which women attain postpartum smoking abstinence; (2) review the literature on randomized controlled trials (RCTs) that test the effects of postpartum smoking relapse prevention interventions that address SHS; (3) determine the validity and reliability of biomarker and self-report measures of prenatal SHS exposure in mother-baby couplets; and (4) examine the relationship between level of prenatal SHS exposure and maternal/infant outcomes using hair nicotine analysis.
An exploratory, qualitative study was conducted with three women who had attained long-term postpartum smoking abstinence. Although some women are able to remain smokefree after delivery, two-thirds relapse within on year (CDC, 2004a). Women who were successful in not smoking after delivery demanded a smoke-free environment; made a conscious decision to replace smoking habits with new healthy behaviors; knew that the initial postpartum period was going to be stressful and could lead to relapse; and viewed abstinence as a lifelong decision. The critical review of RCTs testing the efficacy of relapse prevention interventions and SHS revealed a need for more comprehensive SHS interventions and a clear delineation of abstinence/relapse terminology. A cross-sectional, nonexperimental study with 210 mother-baby couplets showed hair nicotine to be a valid biomarker for prenatal SHS exposure. Pregnant women exposed to SHS were more likely to have maternal and infant complications; deliver babies that weigh less (306 grams); have decreased birthlength (1.4 cm); and have shorter gestational periods.
Key Words: secondhand smoke exposure, pregnancy, postpartum, hair nicotine.
My Research