title: Growth Models of Maternal Smoking Behavior: Individual and Contextual Factors.
abstract: BACKGROUND
  Persistent maternal smoking during pregnancy, reduction or cessation during pregnancy, and smoking initiation or resumption postpartum impel further research to understand these behavioral patterns and opportunities for intervention.
  
  
  OBJECTIVE
  We investigated heterogenous longitudinal patterns of smoking quantity to determine if these patterns vary across three maternal age groups, and whether the influence of individual and contextual risk factors varies by maternal age.
  
  
  METHODS
  Separate general growth mixture models were estimated for mothers ages 15-25, 26-35, and 36+, allowing different empirical patterns of an ordinal measure of smoking behavior at six time points, from preconception through child entry to kindergarten.
  
  
  RESULTS
  We identify five classes for mothers ages 15-25, four classes for ages 26-35, and three classes for ages 36+. Each age group presents classes of nonsmokers and persistent heavy smokers. Intermediate to these ends of the spectrum, each age group exhibited its own smoking classes characterized by the extent of pregnancy smoking reductions and postpartum behavior. In all three age groups, class membership can be distinguished by individual sociodemographic and behavioral characteristics. Co-resident smokers predicted nearly all smoking classifications across age groups, and selected neighborhood characteristics predicted classification of younger (15-25) and older (36+) mothers.
  
  
  CONCLUSIONS
  The design, timing, and delivery of smoking prevention and cessation services, for women seeking to become pregnant and for women presenting for prenatal or pediatric care, are best guided by individual characteristics, particularly maternal age, preconception alcohol consumption, and postpartum depression, but neighborhood characteristics merit further attention for mothers at different ages.
authors.affiliation: a Department of Substance Abuse, Mental Health and Criminal Justice, NORC at the University of Chicago , Bethesda , Maryland , USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mumford
authors.affiliation: a Department of Substance Abuse, Mental Health and Criminal Justice, NORC at the University of Chicago , Bethesda , Maryland , USA.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008423:Maternal Age; D008960:Models, Psychological; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data*; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D055815:Young Adult
keywords: general growth; longitudinal trajectories; mixture model; neighborhood context; ordinal outcomes; pregnancy; smoking