Cigarette smoking in pregnant substance users: Association with substance use and desire to quit.

Decreasing smoking during pregnancy is a priority in both research and clinical practice. In contrast, despite the high prevalence of smoking in pregnant substance users (upward of 90%), smoking-cessation treatment has received relatively little attention in substance use disorder treatment. Several barriers to integrating smoking cessation treatment interventions into SUD treatment have been delineated, including the belief that smoking is unrelated to substance use and that substance using smokers don’t want to quit smoking. Research has demonstrated these beliefs may not be accurate, but less is known about all these factors in pregnant women.

The goal of this secondary analysis was to test hypotheses that in pregnant substance users: (1) cigarette smoking would be associated with greater alcohol and drug use; (2) approximately 50% of smokers would be interested in quitting smoking; and (3) greater self-efficacy and lower perceived difficulty of smoking would be associated with interest in quitting smoking.

Data from a randomized, multisite trial (CTN-0013) with 200 pregnant substance users, 145 (72.5%) of whom smoked at baseline, was analyzed. As predicted: (1) smokers had significantly greater substance use; (2) approximately half of smokers wanted to quit; and (3) smokers with a quit goal had significantly greater self-efficacy and lower perceived difficulty of quitting.

Conclusions: Smoking may be associated with more severe substance use in pregnant substance-using patients, half of whom may be interested in smoking-cessation interventions. These findings highlight the importance of addressing smoking in pregnant substance users. While some work is being done to identify effective smoking-cessation interventions for this population, this remains a significant clinical and research need.

Related protocols: CTN-0013