Document Type

Dissertation - Open Access

Award Date


Degree Name

Doctor of Philosophy (PhD)

Department / School

Biology and Microbiology

First Advisor

Heidi Mennenga


pregnancy, smoking, adverse childhood experiences (ACEs), Pregnancy Risk Assessment Monitoring System (PRAMS)


Cigarette smoking is the most common cause of premature death, killing half of its users. During pregnancy, smoking continues to be the leading cause of premature death for both mothers and newborns. Research has consistently demonstrated smoking is not randomly distributed across populations; it is, instead, socially patterned. Women from lower socioeconomic backgrounds, those experiencing mental health issues, and rural area residents are disproportionately affected. The life course framework emphasizes the impact of exposures in early life on shaping health inequities. Eliminating health inequities, including risky behaviors such as smoking, requires an understanding of the pathways that generate these inequities. Adverse Childhood Experiences (ACEs), defined as traumatic events occurring before age 18, are linked to risky behaviors, including smoking. Yet, few studies that use a life course approach have examined the influence of ACEs on smoking later in life, especially among pregnant women. Furthermore, the literature reveals a notable gap concerning updated data on maternal smoking trends, particularly in relation to sociodemographic and psychological factors, as well as geographic variations within the United States (U.S.). Therefore, the main objectives of this study were to examine the overall trends in cigarette smoking prevalence and cessation during pregnancy in the U.S., with a particular focus on various sociodemographic groups. This includes looking at variations in smoking behaviors across various maternal characteristics and how these trends differ over time. The second objective was to understand how environmental and psychological factors, such as living in rural versus urban areas, ACEs, and depression, influence maternal smoking. This involved investigating the strength of the association between these factors and smoking during pregnancy. Using data from the 2004-2021 Pregnancy Risk Assessment Monitoring System, the findings suggest persistent sociodemographic disparities in smoking, with ACEs being an important predictor. In conclusion, the prevalence of maternal smoking among vulnerable populations highlights ongoing inequalities in pregnancy-related smoking habits. To mitigate the adverse effects of cigarette smoking on mothers and their offspring, it is imperative to understand and address the root causes contributing to maternal smoking, thereby facilitating impactful public health initiatives.

Library of Congress Subject Headings

Psychic trauma in children.
Pregnant women -- Tobacco use.
Fetus -- Effect of tobacco on.
Smoking -- Health aspects.
Pregnancy -- Risk assessment.


South Dakota State University

Available for download on Sunday, December 15, 2024



Rights Statement

In Copyright