Evaluation of four maternal smoking questions

Public Health Rep. Jan-Feb 1999;114(1):60-70. doi: 10.1093/phr/114.1.60.


Objective: The authors evaluated four questions about maternal smoking during pregnancy for use on birth certificates.

Methods: Question 1 (yes/no format) and Question 2 (trimester-specific design) were tested among 1171 women who delivered at two Kaiser Permanente medical centers in northern California. Responses to Questions 1 and 2 were compared with smoking information provided by participants in telephone interviews conducted during pregnancy. Question 3 (multiple choice format) and Question 4 (month- and grouped month-specific design) were tested among 900 women who enrolled in a statewide prenatal screening program and who delivered in 20 hospitals in four Central Valley counties. Responses to Questions 3 and 4 were compared with mid-pregnancy serum cotinine levels. The authors evaluated the four questions in terms of conciseness, response rate, data accuracy, and type of data requested.

Results: Questions 1 and 2 were the most concise. Response rates could not be calculated for Questions 1 and 2. Response rates were 86.0% for Question 3 and 74.2% for Question 4. Sensitivity was 47.3% for Question 1, 62.1% for Question 2, 83.8% for Question 3, and 86.7% for Question 4. The types of data requested by Questions 2 and 4 seem to best satisfy the needs of the broad audience of birth certificate users.

Conclusions: No single question was clearly superior. The authors propose a combination of Questions 2 and 4, which asks about average number of cigarettes smoked per day in the three months before pregnancy and in each trimester of pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Birth Certificates
  • California / epidemiology
  • Cross-Sectional Studies
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Incidence
  • Infant, Newborn
  • Mothers / statistics & numerical data*
  • Pregnancy
  • Pregnancy Trimesters
  • Prenatal Care
  • Smoking / adverse effects
  • Smoking / epidemiology*