title: Tobacco, alcohol, and caffeine use and cessation in early pregnancy.
abstract: OBJECTIVE
  Little is known about what happens when individuals attempt to make multiple behavior changes simultaneously. Pregnant women in particular are often in the position of needing to change several behaviors at once, including giving up more than one pleasurable substance. We investigated the success of pregnant women in spontaneously quitting tobacco, alcohol, or caffeine, alone or in combination.
  
  
  METHODS
  Pregnant women (n = 7489) were identified in the practices of large health maintenance organizations in Seattle and Minneapolis and were interviewed by telephone. Analyses examined the patterns of using and quitting more than one substance, and the extent to which using more than one substance predicts ability to quit other substances.
  
  
  RESULTS
  Use of the three substances tended to cluster within individuals. Users of multiple substances were less likely to quit each substance than users of single substances. However, in the subgroup of multiple substance users who had quit one substance, having quit a second substance was more, rather than less, common. In multivariate analyses predicting quitting, demographic variables, and not having been pregnant previously were significant predictors of quitting each substance; being a nonsmoker predicted quitting alcohol, and being a nonsmoker and nondrinker predicted quitting caffeine.
  
  
  CONCLUSIONS
  The reasons for difficulty in quitting more than one substance are unknown but may include the difficulty of formulating appropriate behavioral strategies or less concern about healthy behavior in pregnancy. Many women in the study successfully quit using two substances, however, and counseling should focus on achieving that outcome.
authors.affiliation: Division of Epidemiology, University of Minnesota, Minneapolis 55454-1015, USA. pirie001@tc.umn.edu
authors.forename: P L
authors.initials: PL
authors.lastname: Pirie
authors.forename: H
authors.initials: H
authors.lastname: Lando
authors.forename: S J
authors.initials: SJ
authors.lastname: Curry
authors.forename: C M
authors.initials: CM
authors.lastname: McBride
authors.forename: L C
authors.initials: LC
authors.lastname: Grothaus
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control; D002110:Caffeine; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D014861:Washington / Q000453:epidemiology
chemical_list: D002110:Caffeine