Smoking During Pregnancy and Its Association with Maternal Health Among Women of Reproductive Age in Alabama: An Analysis Using the Three Delays Model and PRAMS Phase 8 Data.

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Article in Healthcare (Basel, Switzerland), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 author.

John Kwame DuahCollege of Liberal Arts, Department of Political Science, Health Services Administration Program, Auburn University, Auburn, AL 36849, USA.ORCID 0009-0001-4601-4622

Funding

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6 · The paper itself

Abstract

BACKGROUND/

objectivesSmoking during pregnancy endangers maternal and infant health outcomes, posing significant risks such as preterm birth and developmental complications. Applying the Three Delays Framework, this study examines how smoking behaviors impact maternal health in Alabama, focusing on barriers to prenatal care.

methodsThis cross-sectional study utilized PRAMS Phase 8 data collected from 2016 to 2021, comprising 533 observations from the Alabama Department of Public Health. Prenatal care barriers were categorized into three domains: seeking, reaching, and receiving care. Analyses included descriptive statistics, hierarchical clustering of barrier items, derivation of an informational barrier latent score using item-response theory (θ_info), and multivariable logistic regression adjusted for age, race/ethnicity, income, and BMI.

resultsMultivariable logistic regression analysis revealed that informational barriers (OR = 2.42,

conclusionsWhile smoking during pregnancy remains a modifiable health behavior, informational and system barriers emerged as the more immediate determinants of poor maternal outcomes in this cohort. Addressing these barriers through targeted prenatal education initiatives and system-level improvements can enhance care utilization and improve maternal and infant health outcomes, even among pregnant smokers.

Indexed as

Alabamabarriers to carehierarchical clustering analysismaternal healthPRAMSprenatal caresmokingThree Delays Model

Identifiers

PMID40508892

DOI10.3390/healthcare13111277

PMCPMC12154258

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.