Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Eve R. Colson

Second Advisor

Isabelle Von Kohorn

Third Advisor

Dena Schulman-Green


While up to 45% of women quit smoking during pregnancy, nearly 80% return to smoking within a year after delivery. Current interventions to prevent this return have had limited success. The aim of this study was to use the Theory of Planned Behavior to understand the factors influencing intention to resume smoking postpartum, specifically focusing on the role of subjective norms, or the social environment. During the postpartum hospital stay, we conducted in-depth, individual interviews with 24 women who had quit smoking during pregnancy. Over 300 pages of transcripts were analyzed by all four investigators using qualitative methods to identify common themes facilitated by Atlas.ti software. Respondents were predominately white (63%) and primipara (54%) with a mean age of 26. When reflecting on their experiences of being a smoker, the women emphasized the importance of their social relationships. Common themes were: 1) virtually all were embedded in large, complex social networks of smokers (partners, family, friends, co-workers) that influenced their smoking behavior, 2) the subjective norm (the perceived social pressure) for many women was that, while smoking during pregnancy is unacceptable, smoking after pregnancy is tolerable, and 3) partners were particularly influential on these womens smoking behaviors. In conclusion, we found that social environment played a large role in these women's past smoking behavior and future intentions. Thus, this factor may continue to influence their behavior after pregnancy. Further research is needed to establish the generalizability of these findings; however, our study suggests that the influence of the social environment should be integrated into postpartum smoking interventions.


This is an Open Access Thesis.

Open Access

This Article is Open Access