Electronic Theses and Dissertations





Date of Award


Document Type


Degree Name

Doctor of Philosophy


Social and Behavioral Sciences

Committee Chair

Kenneth D Ward

Committee Member

Satish Kedia

Committee Member

Latrice C Pichon

Committee Member

Mzayek Fawaz


Maternal smoking is one of the most preventable causes of adverse birth outcomes and poses substantial health risks for both the mother and child. Evidence suggests that increased stress and depression is associated with smoking behaviors, including smoking cessation and smoking relapse. However, few studies have prospectively examined these associations and no studies have examined neighborhood crime, an important stressor for many low-income women, as a predictor of smoking cessation and relapse among this population. The primary objective of this study was to examine the prospective associations between stress, depression, and pre- and postpartum smoking cessation, and postpartum relapse among low-income pregnant women. We hypothesized that increased baseline stress and depression would be associated with decreased odds of pre- and postpartum cessation and increased odds of postpartum relapse. Further, an exploratory hypothesis was tested that increased neighborhood crime is associated with decreased smoking cessation and increased smoking relapse. Social support was predicted to moderate these associations. Data from 255 low-income pregnant women who previously participated in a longitudinal study were used. Most participants were Caucasian (57%) and African American (40%), mean age 24 (SD = 5.2) years at baseline. All participants smoked regularly during the month prior to becoming pregnant and 49 (19.2%) reported being quit at baseline. Adjusted multivariable finding revealed that perceived stress, depression and social support were not statistically significantly associated with smoking cessation outcomes or relapse. Further, exploratory multivariable analyses revealed that women who were exposed to higher than average crime (OR = 0.18, 95% CI 0.05 - 0.66), aggravated assaults (OR = 0.13, 95% CI 0.03 - 0.55), rapes, (OR = 0.17, 95% CI 0.05 - 0.68), robberies (OR 0.17, 95% CI 0.05 - 0.64), and burglaries (OR= 0.20, 95% CI 0.06 - 0.72) within one mile of their home were less likely to quit smoking postpartum compared to women who were exposed to no crime (all p-values <.037). Results indicate that neighborhood crime exposure may be an important contributor to the high risk of smoking relapse that low-income women experience after having a baby. More research is needed to further elucidate the association between stress, neighborhood crime, and smoking cessation among low-income pregnant women.


Data is provided by the student.

Library Comment

dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.