Most studies of maternal tobacco cessation during pregnancy have estimated measures of effect that can be useful in identifying the exposure as an etiologic risk factor in maternal and child health. However, in the case of maternal tobacco use there is overwhelming evidence for a causal role in adverse infant outcomes, and public health needs to focus on measures of potential impact in order to better prioritize and allocate resources toward interventions. The aims of this dissertation were: 1) to investigate the public health impact of smoking cessation during pregnancy among mothers giving birth in San Bernardino County, California; and 2) to examine the relationship between indices of prenatal care utilization and smoking cessation during pregnancy.

The first study showed that, among 65,228 total live births in 2007 and 2008, a single low birth weight or preterm outcome in the county could have been prevented either by at least 35 mothers quitting smoking during pregnancy or by 25 mothers being never smokers during pre-pregnancy.

The second study among 4,059 women reporting tobacco use in San Bernardino County found a dose-response relationship for prenatal care initiation in which women were more likely to quit smoking for every two months earlier they initiated their prenatal care visits. Examining the adequacy of received prenatal care services indicated a threefold increase in odds of smoking cessation for women receiving more than half the number of prenatal care visits recommended by the American College of Obstetricians and Gynecologists.

Based on the findings from these studies of San Bernardino County we can conclude that there is a burden of adverse infant outcomes due to maternal smoking that can be reduced by relatively small numbers of women quitting smoking during pregnancy. We gained the additional insight from analysis of maternal smokers that indicated that those with adequate prenatal care utilization were most likely to quit smoking during their pregnancy.

LLU Discipline



School of Public Health

First Advisor

Pramil N. Singh

Second Advisor

Jayakaran Job

Third Advisor

Serena Tonstad

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Pregnant women -- Tobacco use; Smoking cessation -- San Bernardino County; Health promotion -- San Bernardino County; Smoking -- in pregnancy; Smoking Cessation; Maternal Exposure -- adverse effects; Maternal Welfare; Prenatal Care -- utilization -- San Bernardino County; Health Promotion -- utilization -- San Bernardino County; Pregnancy Outcome -- San Bernardino County -- statistics -- 2007-2008; Infant, Newborn -- San Bernardino County -- statistics -- 2007-2008; Cohort Studies.



Page Count

xii; 97

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives