Over the past decade, cigarette smoking among female adolescents has emerged as a major social issue. Between 1975 and 1985, initiation of smoking declined among young men while it increased among young women (Pierce, Fiore, Novotny, Hatziandreu, & Davis, 1989). Female adolescents are more likely to smoke cigarettes than are their male counterparts--20% vs. 16%, respectively (U.S. Department of Health and Human Services, 1988). Paralleling the use of tobacco by female adolescents, one million teenage pregnancies occur annually (Alan Guttmacher Institute, 1989). Although the actual percentage is not available, studies have reported that between 28% and 42% of pregnant teenagers smoke (Davis, Trollestrup, & Milham, 1990; Prager, Malin, Spiegler, Van Natta, & Placek, 1984).
Smoking during pregnancy is detrimental to the health of the fetus, the newborn, and to the infant (Butler & Goldstein, 1973; Fogelman, 1980; Harlap & Davies, 1974; Land & Stockbauer, 1987). It has been associated with low infant birth weight (U.S. Department of Health and Human Services, 1983); perinatal and neonatal mortality (Malloy, Kleinman, Land, & Shramm, 1988; Naeye & Peters, 1984); intrauterine growth retardation (Hickey, Clelland, & Bowers, 1978; Sachs, 1987); delayed reading ability (Bulter & Goldstein, 1973); and short attention span (Naeye & Peters, 1984). Duffy and Coates (1989) also found that these risks are greater for teenagers who smoke.
Although a plethora of clinical and behavioral research has focused on smoking among adolescents, few studies have explored tobacco use among low-income, pregnant youths. Type of residence, peer networks, and beliefs about the acceptability of smoking are differing factors among socioeconomic groups and may provide incentives to smoke (Novotny, Warner, Kendrick, & Remington, 1988; McGraw, Smith, Schensul, & Carillo, 1991). To enhance the effectiveness of smoking-prevention programs directed at low-income pregnant adolescents, it is important to understand their perceptions of tobacco use. This paper describes the beliefs and attitudes of smoking among low-income pregnant teenagers. First, it reviews the literature on adolescent smoking. Second, it considers the benefits these teenagers obtain from smoking. Third, suggestions are offered to improve smoking-prevention programs.
DETERMINANTS OF ADOLESCENT SMOKING PATTERNS
Female adolescents comprise the largest percentage of new smokers (U.S. Department of Health and Human Services, 1992). Annually, 3 million American young women under age 18 consume 947 million packs of cigarettes (U.S. Department of Health and Human Services, 1992). Thirty-six percent of females who use tobacco smoke a pack or more of cigarettes daily (U.S. Department of Health and Human Services, 1992). Further, female adolescents appear less responsive to smoking-preventive messages and are less likely to quit smoking as compared to male adolescents (Gilchrist, Schinke, & Nurius, 1989). Indeed, being female has been identified as a predictor of smoking status (Brunswick & Messeri, 1984; Goddard, 1992).
Socioeconomic status has been implicated in the onset of cigarette use among adolescents (Brunswick & Messeri, 1984). Teenagers from lower socioeconomic backgrounds are more likely to smoke than are their middle-class counterparts (Eckert, 1983; Murray, Swann, Bewley, & Johnson, 1983). Similar class differences emerge with pregnant smokers (Graham, 1976). Middle-class pregnant adolescents are more likely to reduce or to quit smoking during pregnancy than are those in the lower class (Davis et al. 1990). This difference in smoking patterns may reflect divergent beliefs about tobacco use based on socioeconomic status (Graham, 1976). Moreover, cigarette advertising has influenced low-income youths beliefs and attitudes about tobacco use. …