摘要：Objectives. Associations between subjective social status, a subjective measure of socioeconomic status, and predictors of risk for postpartum smoking were examined among 123 pregnant women (aged 18–24 years) who stopped smoking because of pregnancy. The goal was to identify how subjective social status might influence the risk for postpartum smoking and to elucidate targets for intervention. Methods. We used multiple regression equations to examine the predictive relations between subjective social status and tobacco dependence, self-rated likelihood of postpartum smoking, confidence, temptations, positive and negative affect, depression, stress, and social support. Adjusted analyses were also conducted with control for race/ethnicity, education, income, and whether participant had a partner or not (partner status). Results. In unadjusted and adjusted analyses, subjective social status predicted tobacco dependence, likelihood of postpartum smoking, confidence, temptations, positive affect, negative affect, and social support. Adjusted analyses predicting depression and stress approached significance. Conclusions. Among young pregnant women who quit smoking because of pregnancy, low subjective social status was associated with a constellation of characteristics indicative of increased vulnerability to postpartum smoking. Subjective social status provided unique information on risk for postpartum smoking over and above the effects of race/ethnicity, objective socioeconomic status, and partner status. Tobacco smoking is the single largest behavioral contributor to disease 1 and is an important determinant of socioeconomic disparities in the incidence and mortality of disease. 2 , 3 Pregnancy represents a unique public health opportunity to capitalize on high rates of spontaneous cessation of smoking. 4 , 5 Unfortunately, although up to half of all pregnant women who smoke stop smoking or refrain from smoking during their pregnancies, 6 – 9 the vast majority of women return to smoking after they give birth. Nearly half relapse within 3 months of delivering their babies, and approximately 80% of women relapse within 1 year. 6 , 7 , 10 – 12 Thus, there is a critical need to identify simple, easily measured markers of increased risk for postpartum smoking. Tobacco smoking has become increasingly concentrated among those with the lowest levels of education, income, and occupational status, 13 – 17 and young adult women comprise a growing proportion of these individuals. 18 , 19 In addition to having a higher prevalence of smoking, individuals with lower socioeconomic status (SES; typically assessed by education, income, or occupation 20 ) tend to be less successful at quitting smoking. 21 – 23 This socioeconomic gradient in smoking prevalence and cessation has been demonstrated among pregnant women as well. 24 Recent data indicate that smokers with a higher SES are more likely than those with a lower SES to use effective resources for quitting smoking and to have more restrictive home environments in terms of smoking, which appears to partially explain their higher cessation rates. 25 Although numerous studies have found that objective indicators of SES, particularly education, were strongly associated with smoking prevalence and cessation, no studies have examined the association between subjective perceptions of SES and predictors of smoking relapse during pregnancy or in the postpartum period (conceivably any time after the birth of a baby, but in most research referred to as the year following birth). Subjective social status reflects an individual’s perception of her or his position in the social hierarchy. 26 Subjective social status has been identified as a significant predictor of self-rated health among racially and ethnically diverse pregnant women, even among racial/ethnic subgroups of women for whom objective SES measures were found to be unrelated to self-rated health. 20 Unlike traditional objective indicators of SES, such as education and income, subjective social status captures relative class standing in one’s community and taps into perceptions of perceived inequality, and for this reason may demonstrate a stronger relationship with health behaviors. 27 Our goal was to examine the relations between subjective social status and established predictors of postpartum smoking within a racially and ethnically diverse, low-SES sample of young adult pregnant women aged 18–24 years.
