Positive smoking history as a preliminary screening device for substance use in pregnant adolescents

To assess the utility of a history of smoking as a clinical indicator of substance use in pregnant adolescents.

A secondary analysis of a subsample of all 15- to 19-year-old live-birth mothers (N = 1640) taken from the 1988 National Maternal and Infant Health Survey (NMIHS). Self-reported data were weighted and analyzed covering ethnicity, substance use, socioeconomic status, and prenatal care. Contingency table analysis and stepwise logistic regression were applied to compare the prevalence of other forms of substance use among smokers versus nonsmokers, and to evaluate whether a history of smoking made a unique contribution to identifying adolescents at increased risk for use of other substances. The specific substances studied were alcohol and cocaine which are known to be important contributors to perinatal morbidity and mortality.

In this multiethnic, nationally representative subsample of pregnant adolescents, 35% reported a positive history of tobacco use 12 months before delivery. Another 32% had consumed alcohol, 9% had used marijuana, and about 1.5% had reported some use of cocaine or crack. The findings show greater use of tobacco by whites, non-Hispanics, the ever married, and women receiving prenatal care in the private sector. Fifty-three percent of all admitted users of alcohol or cocaine smoked cigarettes 12 months before delivery. Logistic regression shows that smokers were four times more likely to use alcohol or cocaine than nonsmokers when controlling for other sociodemographic and economic variables.

Substance use is common in pregnant adolescents from all ethnic and economic backgrounds. Self-report of smoking may be useful in screening for adolescents at risk for using cocaine or alcohol during pregnancy.