title: Environmental tobacco smoke avoidance among pregnant African-American nonsmokers.
abstract: BACKGROUND
  Environmental tobacco smoke (ETS) exposure during pregnancy contributes to adverse infant health outcomes. Limited previous research has focused on identifying correlates of ETS avoidance. This study sought to identify proximal and more distal correlates of ETS avoidance early in pregnancy among African-American women.
  
  
  METHODS
  From a sample of low-income, black women (n=1044) recruited in six urban, prenatal care clinics (July 2001-October 2003), cotinine-confirmed nonsmokers with partners, household/family members, or friends who smoked (n=450) were identified and divided into two groups: any past-7-day ETS exposure and cotinine-confirmed ETS avoidance. Bivariate and multivariate logistic regression analyses identified factors associated with ETS avoidance. Data were initially analyzed in 2004. Final models were reviewed and revised in 2007 and 2008.
  
  
  RESULTS
  Twenty-seven percent of pregnant nonsmokers were confirmed as ETS avoiders. In multivariate logistic regression analysis, the odds of ETS avoidance were increased among women who reported household smoking bans (OR=2.96; 95% CI=1.83, 4.77; p<0.0001), that the father wanted the baby (OR=2.70; CI=1.26, 5.76; p=0.01), and that no/few family members/friends smoked (OR=3.15; 95% CI=1.58, 6.29; p<0.001). The odds were decreased among women who had a current partner (OR=0.42; 95% CI=0.23, 0.76; p<0.01), reported any intimate partner violence during pregnancy (OR=0.43; 95% CI=0.19, 0.95; p<0.05), and reported little social support to prevent ETS exposure (OR=0.50; 95% CI=0.30, 0.85; p=0.01). Parity, emotional coping strategies, substance use during pregnancy, partner/household member smoking status, and self-confidence in avoiding ETS were significant in bivariate, but not multivariate analyses.
  
  
  CONCLUSIONS
  Social contextual factors were the strongest determinants of ETS avoidance during pregnancy. Results highlight the importance of prenatal screening to identify pregnant nonsmokers at risk, encouraging household smoking bans, gaining support from significant others, and fully understanding the interpersonal context of a woman's pregnancy before providing behavioral counseling and advice to prevent ETS exposure.
authors.affiliation: Department of Prevention and Community Health, School of Public Health and Health Services, The George Washington University Medical Center, Washington, DC 20037, USA. smblake@gwu.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Blake
authors.forename: Kennan D
authors.initials: KD
authors.lastname: Murray
authors.forename: M Nabil
authors.initials: MN
authors.lastname: El-Khorazaty
authors.forename: Marie G
authors.initials: MG
authors.lastname: Gantz
authors.forename: Michele
authors.initials: M
authors.lastname: Kiely
authors.forename: Dana
authors.initials: D
authors.lastname: Best
authors.forename: Jill G
authors.initials: JG
authors.lastname: Joseph
authors.forename: Ayman A E
authors.initials: AA
authors.lastname: El-Mohandes
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D003367:Cotinine / Q000032:analysis; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior; D012944:Social Support; D019966:Substance-Related Disorders / Q000208:ethnology / Q000523:psychology; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D014505:Urban Population / Q000706:statistics & numerical data; D014754:Violence / Q000523:psychology; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine