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.
","abstract_html":"<p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p>","abstract_has_math":false,"creators":["Batech, Michael"],"institution":null,"degree_name":"Doctor of Public Health (DrPH)","degree_level":"Dissertation","degree_discipline":null,"degree_department":null,"school":null,"contributors":["Pramil N. Singh","Jayakaran Job","Serena Tonstad"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2013,"date_issued":"2013-06-01T07:00:00Z","date_published":"2013-06-01T07:00:00Z","updated_at":"2026-07-24T02:53:44Z","subjects":["Epidemiology","Maternal and Child Health","Public Health","Public Health Education and Promotion","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."],"languages":["English"],"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."],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://scholarsrepository.llu.edu/etd/1444","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Pramil N. Singh","Jayakaran Job","Serena Tonstad"]},{"key":"dc:creator","label":"Author","values":["Batech, Michael"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"thesis:degree_level","label":"Degree Level","values":["Dissertation"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Public Health (DrPH)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Epidemiology","Maternal and Child Health","Public Health","Public Health Education and Promotion","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."]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["English"]},{"key":"dc:rights","label":"Dc Rights","values":["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."]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://scholarsrepository.llu.edu/etd/1444"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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.
"]},{"key":"dc:title","label":"Title","values":["The Public Health Impact of Maternal Smoking Cessation during Pregnancy : The San Bernardino County Experience"]}]}],"canonical_facts":{"dc:contributor":["Pramil N. Singh","Jayakaran Job","Serena Tonstad"],"dc:creator":["Batech, Michael"],"dc:description.abstract":["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.
"],"dc:identifier":["https://scholarsrepository.llu.edu/etd/1444"],"dc:language":["English"],"dc: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."],"dc:subject":["Epidemiology","Maternal and Child Health","Public Health","Public Health Education and Promotion","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."],"dc:title":["The Public Health Impact of Maternal Smoking Cessation during Pregnancy : The San Bernardino County Experience"],"thesis:degree_level":["Dissertation"],"thesis:degree_name":["Doctor of Public Health (DrPH)"]},"updated_at":"2026-07-24T02:53:44Z"}