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Mothers who smoke can create serious health risks in their children. Research has shown that increased smoking is linked to less social support in women, as well as to more stress. Additionally, a study by Fried and Watkinson (1988) showed that mothers who smoke more provide less stimulating home environments for their children. This study examined social support, parenting stress, and home environments for mothers of 6- and 15-month-old infants using preliminary data in the Emory Language Development Study. Results indicate that, while smokers and nonsmokers do not differ in parenting stress or home environment, social support was significantly lower for heavier smokers than for those who did not smoke. This means that helping mothers to quit could require optimizing their social networks. I also consider some possible explanations for the significant differences that were found between races on the HOME Inventory.
As exposure to tobacco smoke is a preventable health risk, it is important to explore the reasons individuals, particularly mothers, smoke during pregnancy and continue to smoke. Research has shown that, for women especially, a lack of social support is related to increased smoking. For instance, Romano, et al. (1991) found that women with low social support are 3.1 times more likely to smoke than women with high social support. Yet other researchers (Latimer & Sheahan, 1995; Paarlberg, et al., 1999) have found no differences between smokers and nonsmokers. One aim of this study is to illuminate the relationship between social support and smoking.
Another aim is to see how smoking is related to the amount of stress a person experiences. In samples that included low income and middle income individuals, those of different races, as well as pregnant women, higher stress was related to increased smoking (Latimer & Sheahan, 1995; Paarlberg, et al., 1999; Romano, et al., 1991). This study will examine a particular form of stress—that is, stress that arises from the role of parent, which could be due to personal factors, negative parent-child interactions, or the behavior of the child.
The final aim is to look into the home environments of families with mothers who smoke. Fried and Watkinson (1988) found that nicotine use was negatively related to scores on the HOME Inventory and its subscales. This study will attempt to replicate those results.
There are three hypotheses:
1. Smoking more will be related to less social support.
2. Smoking more will be related to more parenting stress.
3. Smoking more will be related to less supportive home environments.
Measures
The Family Support Scale (FSS) is a self-report measure consisting of 18 items. Participants are asked to rate the people and groups listed on how helpful they have been to the participant. It uses a scale from 1 (not at all helpful) to 5 (extremely helpful). Higher scores indicate higher average support in raising a child.
The Parenting Stress Index-Short Form (PSI) is a self-report measure that asks participants to rate the degree to which they agree with 36 statements. Higher scores indicate higher levels of stress associated with the parenting role.
The Infant/Toddler HOME Inventory is based on a 45 to 90 minute observation and interview in the home of the parent. The 45 items are grouped into six subscales: Emotional/Verbal Responsivity to Mother, Avoidance of Restriction and Punishment (Acceptance), Organization of the Physical and Temporal Environment, Provision of Appropriate Play Materials, Maternal Involvement with the Child, and Opportunities for Variety in Daily Stimulation. Higher scores reflect an environment that is more stimulating to children and supportive of their intellectual development.
Participants were recruited from postpartum units at Northside Hospital in Atlanta, Georgia, the largest labor and delivery center in the Southeast. Participants and their infants are assessed at three points in time as part of a longitudinal study. The FSS and PSI were administered when infants were approximately 6 months old. The HOME Inventory was scored during a home visit when the infants were approximately 15 months old.
Participants were grouped into 4 categories and compared using the amount they smoked at the time when the measure was taken.
Family Support Scale
There was a significant difference by level of smoking and amount of social support (F = 2.819, p < .05). A Tukey post hoc test showed the difference to be between nonsmokers and heavy smokers (see Figure 1).
Mothers who smoke more report having less help in raising their children than mothers who do not smoke.
Parenting Stress Index and HOME Inventory
Those who smoked more reported higher levels of stress and had less stimulating home environments, but the differences were not significant. This was true even when controlling for demographic aspects.
Correlations
Non-significant relationships existed between the Home Observation and both the Family Support Scale and the Parenting Stress Index. A negative, moderate and significant relationship existed between the Parenting Stress Index and Family Support Scale (r = -.412, p < .001) (see Table 2).
Mothers who reported higher levels of social support also reported stress associated with parenting.
Prenatal Exposure
50-60% of the infants in the sample were prenatally exposed to tobacco (at least 1 cigarette per day at any point during pregnancy). There were no differences on the Home Observation or the Parenting Stress Index for mothers whose infants were exposed compared to mothers whose infants were not. There were significant differences on the Family Support Scale (t(184) = 2.718, p < .01).
Mothers whose infants had not been prenatally exposed reported having more social support than mothers whose infants had been exposed.
Other Variables
There were no significant differences on the FSS or PSI by race, income, or marital status.
Significant differences were found on the HOME by race (F(2) = 12.014, p < .001) (see Figure 2). The differences by race remained even when controlling for marital status and income (F(2) = 4.355, p = .019). Additionally, there were differences by race on three subscales (Acceptance: F(2) = 4.336, p = .017; Play Materials: F(2) = 9.456, p < .001; Variety: F(2) = 4.660, p = .013), even when controlling for marital status and income. (Acceptance was marginally significant (p = .055) when controlling for marital status and income.)
Significant differences by marital status (F(2) = 4.516, p = .014) were no longer significant when controlling for income and race (F = 1.905, p = .157).
White mothers scored significantly higher than African-American mothers on the total score and three subscales: Acceptance, Play Materials, and Variety. Table 4 shows individual items that were significantly different (p < .05) by race.
This study supported previous research in finding that increased tobacco use is related to less social support in women. There was also a significant relationship between the strength of a mother’s support networks and the amount of stress she feels in her role as parent.
Additionally, I found a relationship between social support and prenatal exposure. This could be explained by maternal characteristics—such as depression, which lead to smoking as a form of coping, or it could be due to child characteristics such as behavior problems stemming from prenatal exposure.
No differences were found in home environment by the amount the mother smoked. In this sample, medians on the Home Observation were higher than what has been reported in national samples (Caldwell & Bradley, 2003; see Table 3). The high scores in this sample may have obscured a relationship as reported in Fried and Watkinson (1988). Another factor could be that their sample was 40% White and 60% African-American, while my sample was about 60% White. In previous research, Whites tend to score better.
Some posit that the racial differences on the Home Observation are due to culture, but they could also be artifacts of the measure itself. For instance, while 64% of Whites own pets, while only 30% of African-Americans do (Taylor, et al., 2006). Further study could determine how much this item contributes to determining the quality of a home. Of course, performance on an individual item does not alone determine if the child is in a high-quality environment (Caldwell & Bradley, 2003). Nevertheless, it is possible to have a balance of items that give different types of homes a chance to score well (e.g. having an item that pertains to most African-Americans but only some Whites).
Finally, some have criticized the measure for being insensitive to higher scoring homes, as well as having differential validity for different racial groups. For instance, some studies have seen high correlations with IQ for White children, but the same correlations are lower for African-American children. Though this measure has been in use for a long time, it may be necessary to conduct further analyses to determine if it is sensitive enough and has similar validity for diverse samples.
In conclusion, this research shows how many factors influence a family. A mother’s smoking can be related to stress, lack of support, or feelings of frustration. Her smoking will not only affect her own health, but the health of her children and those around her. When attempting to address such concerns, it is important for practitioners to consider several aspects of a mother’s life and how they interact with each other
I would like to thank Dr. Coles, Julie Carroll, the Outreach Staff of the ELDS, and Chris Foster for their assistance and support in completing this project.
This material is based upon work supported by the Howard Hughes Medical Institute under Grant No. 52003727 and by the National Science Foundation under Award #0450303 (Subaward #I-66-606-63 to Emory University).
1 Caldwell, B.M. & Bradley, R.H. (2003). HOME Inventory administration manual: Standard edition. Little Rock, AR: Print Designs, Inc.
2 Dunst, C.J., Trivette, C.M., & Deal, A.G. (1988). Enabling and empowering families: Principles and guidelines for practice. Cambridge, MA: Brookline Books.
3 Elardo, R. & Bradley, R. H. (1981). The HOME Observation for Measurement of Environment (HOME) Scale: A Review of Research. Developmental Review, 1, 113-145.
4 Fried, P.A., & Watkinson, B. (1988). 12- and 24-month neurobehavioral follow-up of children prenatally exposed to marihuana, cigarettes, and alcohol. Neurotoxicology & Teratology, 10, 305-313.
5 Latimer, M., & Sheahan, S.L. (1995). Correlates of smoking, stress, and depression among women. Health Values: The Journal of Health Behavior, Education & Promotion, 19(1), 29-37.
6 Paarlberg, K.M., Vingerhoets, A.J.J.M., Heinen, A.G.J.J., Dekker, G.A., Van Geijn, H.P. (1999). Psychology and Health, 14(1), 87-96.
7 Romano, P.S., Bloom, J., & Syme, L. (1991). Smoking, social support, and hassles in an urban African-American community. American Journal of Public Health, 81(11), 1415-1423.
8 Taylor, P., Funk, C., Craighill, P. (2006). Gauging Family Intimacy: Dogs Edge Cats (Dads Trail Both). Pew Research Center Report. Obtained July 24, 2006 from http://pewresearch.org/social/pack.php?PackID=3.
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