title: Pathways From Socioeconomic Status to Prenatal Smoking: A Test of the Reserve Capacity Model.
abstract: BACKGROUND
  Low-income, unemployed women with low levels of education are more likely to smoke during pregnancy compared to their higher-income, employed, and well-educated counterparts. The reserve capacity model (RCM) offers a theoretical framework to explain how psychosocial factors may serve as pathways connecting socioeconomic status (SES) to health behaviors. Research supports the link between prenatal smoking and several psychosocial variables such as chronic stressors, depressive symptoms, and social support. How these variables interrelate to explain the predominance of prenatal smoking in lower socioeconomic groups of pregnant women has not been fully elucidated.
  
  
  OBJECTIVE
  The aim of this study was to test the RCM to evaluate the roles of early pregnancy levels of chronic stress, quality of the primary intimate relationship, and depressive symptoms in explaining the relationship between SES and persistent prenatal smoking.
  
  
  METHODS
  A secondary analysis of data from 370 pregnant nonsmokers, spontaneous quitters, and persistent prenatal smokers was conducted. On the basis of the RCM, chronic stressors, depressive symptoms, and the quality of the primary intimate relationship were evaluated as potential mediating variables linking SES with persistent prenatal smoking using path analysis.
  
  
  RESULTS
  Path analyses indicated that a simple model with all three psychosocial variables as mediators of the relationship between SES and persistent prenatal smoking provided the best fit.
  
  
  CONCLUSIONS
  Findings indicated that chronic stressors, depressive symptoms, and the quality of the primary intimate relationship play important roles in the pathway from SES to prenatal smoking status. This knowledge can assist in the development of prevention and intervention strategies to target these variables and ultimately reduce prenatal smoking.
authors.affiliation: Irene Yang, PhD, RN, is Postdoctoral Fellow, Emory University School of Nursing, Atlanta, Georgia. Lynne A. Hall, DrPH, RN, is Professor and Associate Dean for Research, University of Louisville School of Nursing, Kentucky. Kristin Ashford, PhD, APRN, is Associate Professor, University of Kentucky College of Nursing, Lexington. Sudeshna Paul, PhD, is Assistant Research Professor, Emory University School of Nursing, Atlanta, Georgia. Barbara Polivka, PhD, RN, is Professor and Shirley B. Powers Chair in Nursing, University of Louisville School of Nursing, Kentucky. S. Lee Ridner, PhD, FNP-BC, is Associate Dean for Graduate Programs, University of Louisville School of Nursing, Kentucky.
authors.forename: Irene
authors.initials: I
authors.lastname: Yang
authors.forename: Lynne A
authors.initials: LA
authors.lastname: Hall
authors.forename: Kristin
authors.initials: K
authors.lastname: Ashford
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Paul
authors.forename: Barbara
authors.initials: B
authors.lastname: Polivka
authors.forename: S Lee
authors.initials: SL
authors.lastname: Ridner
mesh_terms: D001294:Attitude to Health; D005260:Female; D006801:Humans; D008425:Maternal Behavior / Q000523:psychology*; D008960:Models, Psychological; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods*; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D000074606:Smoking Prevention; D012959:Socioeconomic Factors