Graduation Term


Document Type


Degree Name

Doctor of Philosophy (PhD)


Mennonite College of Nursing

Committee Chair

Kim S Astroth


The purpose of this study was to explore pregnant women’s perception of risk related to tobacco use during pregnancy. A concept analysis of pregnant women’s perception of risk related to substance use is included in Chapter 1. Pregnant women’s perception of substance use risk is more than knowledge of risk but instead an internalization of personal risk based on belief in susceptibility and severity of harm. In Chapter 2, a literature review was conducted to review the current state of the literature regarding pregnant women’s perception of tobacco use risk during pregnancy. The literature review supports low risk perception among pregnant women who continued to tobacco. Chapter 3 includes a cross-sectional, predictive correlational study which was completed at two prenatal clinics, including a federally funded community health clinic and a private prenatal clinic. Pregnant women, 18 years or older, 24 weeks gestation or greater, including women who currently used tobacco, quit using tobacco, or never used tobacco were invited to participate. Women were surveyed during their prenatal appointments, utilizing the Maternal Antenatal Attachment Scale, the Perceived Stress Scale, the Modified Perception of Pregnancy Risk Questionnaire, and socioeconomic questions to determine if maternal-fetal attachment, perceived stress, and perceived tobacco use risk predicts tobacco use status during pregnancy. Results included higher perceived tobacco use risk predicted women were likely to not currently use tobacco. Maternal-fetal attachment and perceived stress were not predictors of tobacco use status. A woman’s choice to continue using tobacco during pregnancy is complex and personal. Understanding the impact of her personal perception of tobacco use risk can assist providers with conversations and improve interventions, leading to increased cessation success and subsequently improve pregnancy and neonatal health outcomes.


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