Smoking status, reading level, and knowledge of tobacco effects among low-income pregnant women

Prev Med. 2001 Apr;32(4):313-20. doi: 10.1006/pmed.2000.0815.


Background: Smoking during pregnancy increases the health risks of the unborn child as well as the mother. Although smoking rates for the population as a whole have declined drastically in the past generation, since 1992 there has been an increase in smoking among women, teenagers, and adults living in poverty. The purpose of this study was to assess reading level, tobacco knowledge, attitudes, and practices of tobacco use among pregnant adult and adolescent women in the public health system in north Louisiana.

Methods: A convenience sample of 600 pregnant women was interviewed in person in the Obstetrics Clinics at Louisiana State University Health Sciences Center at Shreveport and E.A. Conway in Monroe. The structured interview contained detailed questions about smoking practices, tobacco knowledge, and attitudes. Reading was assessed using the Rapid Estimate of Adult Literacy in Medicine. Smoking practices were assessed by self-report and verified by measuring urine cotinine levels. The Cochran-Mantel-Haenszel test was used to estimate the relationship between reading level and knowledge and attitude; multiple logistic regression was used to determine which variable(s) predicted current smoking practices.

Results: Knowledge about the effects of smoking and concern about the health effect of smoking on their baby varied significantly by reading level, with participants with higher reading levels having more knowledge and greater concern. Smoking practices did not vary by reading level even when race, age, and living with a smoker were controlled. Race was a significant determinant of smoking practices, with more white women reporting currently smoking during pregnancy than African Americans (34% vs 8%).

Conclusions: Reading level was related to knowledge about health effects of smoking. Women with higher reading levels were also more concerned about the adverse health effects of smoking on themselves and their babies. However, reading level was not correlated with smoking prevalence. The most significant determinant of smoking was race (with whites smoking significantly more than African Americans).

MeSH terms

  • Adolescent
  • Adult
  • African Americans
  • Biomarkers / urine
  • Chi-Square Distribution
  • Cotinine / urine
  • European Continental Ancestry Group
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Logistic Models
  • Maternal Behavior
  • Multivariate Analysis
  • Patient Education as Topic*
  • Pregnancy
  • Prenatal Care / statistics & numerical data*
  • Smoking / adverse effects*
  • Smoking / epidemiology
  • Smoking / urine
  • Socioeconomic Factors
  • Surveys and Questionnaires


  • Biomarkers
  • Cotinine