Maternal and Child Health Journal

, Volume 22, Issue 5, pp 685–693 | Cite as

Trends in Smoking and Smoking Cessation During Pregnancy from 1985 to 2014, Racial and Ethnic Disparity Observed from Multiple National Surveys

  • Hongxia Li
  • Andrew R. Hansen
  • Zachary McGalliard
  • Laura Gover
  • Fei Yan
  • Jian Zhang


Objective Current report assessed the trends in smoking prevalence and the percentage of smoking cessation during pregnancy among women from three major races/ethnicities. Methods Data were collected between 1999 and 2014 from the continuous National Health and Nutrition Examination Survey (NHANES). Smoking habits of women while pregnant with the child sampled by NHANES were assessed retrospectively. A total of 28,090 women who gave live birth between 1985 and 2014 were included. The prevalence ratios (PRs) of smoking and quitting smoking during pregnancy were calculated. The adjusted annual prevalence ratio (aaPR: the ratio associated with a 1-year increase in time) was estimated using logistic regression with the year of birth as a predictor. Results With child’s race/ethnicity, gender, and mother’s age controlled, the aaPR of smoking was 0.95 (95% confidence interval 0.92–0.97) for Hispanics, 0.96 (0.94–0.98) for whites, and 0.98 (0.94–1.00) for blacks. The aaPR of quitting smoking was 1.09 (1.02–1.16) for Hispanics, 1.01 (0.97–1.06) for whites, and 1.03 (0.95–1.12) for blacks. Compared with the counterparts aged 35 years or older, pregnant women younger than 20 years were more likely to smoke among whites [PR 1.56 (1.07–2.29)] but less likely among blacks [PR 0.37 (0.26–0.52)]. Conclusions for Practice Smoking prevalence has been declining continuously for all but at different rates among three major races/ethnicities. The risk profiles of smoking during pregnancy were race/ethnicity specific. Culturally appropriate programs should be developed to further reduce the maternal smoking during pregnancy.


Maternal smoking Pregnancy Smoking prevalence rate Smoking cessation NHANES 



Confidence interval


Healthy people 2020


National Health and Nutrition Examination Survey


Pregnancy Risk Assessment Monitoring System


Standard error



We are indebted to the students, who have contributed substantially to the early drafts with care. The comments and editorial assistance from these students have been especially helpful, Adrian Badana, Gloria Barnett, Bionca Davis, Jamesa Hogges, Ogechi Imala, Krystina Johnson, Sushma Kurella, Wayne Lawrence, Maria Politis, Keisha Pressley, Kayin Robinson.


The project was done with no specific funding. However, the special training Grant from the School of Public Health, Fudan University, Shanghai, China, made it possible to update the current report with the release of NHANES survey 2013–2014.

Compliance with Ethical Standards

Conflict of interest

There is no conflict of interest to be declared, and no honorarium, grant, or other form of payment was given to anyone to produce the manuscript.


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Authors and Affiliations

  1. 1.Department of Social Medicine, School of Public HealthFudan UniversityShanghaiPeople’s Republic of China
  2. 2.Shanghai East HospitalTongji University, School of MedicineShanghaiChina
  3. 3.Department of Community Health Behavior and Education, Jiann-Ping Hsu College of Public HealthGeorgia Southern UniversityStatesboroUSA
  4. 4.Department of Epidemiology, Jiann-Ping Hsu College of Public HealthGeorgia Southern UniversityStatesboroUSA

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