Tobacco, alcohol, and caffeine use and cessation in early pregnancy

Objectives: Little is known about what happens when individuals attempt to make multiple behavior changes simultaneously. Pregnant women in particular are often in the position of needing to change several behaviors at once, including giving up more than one pleasurable substance. We investigated th e success of pregnant women in spontaneously quitting tobacco, alcohol, or caffeine, alone or in combination. Methods: Pregnant women (n = 7489) were identified in the practices of larg e health maintenance organizations in Seattle and Minneapolis and were inte rviewed by telephone. Analyses examined the patterns of using and quitting more than one substance, and the extent to which using more than one substa nce predicts ability to quit other substances. Results: Use of the three substances tended to cluster within individuals. Users of multiple substances were less likely to quit each substance than u sers of single substances. However, in the subgroup of multiple substance u sers who had quit one substance, having quit a second substance was more, r ather than less, common. In multivariate analyses predicting quitting, demo graphic variables, and not having been pregnant previously were significant predictors of quitting each substance; being a nonsmoker predicted quittin g alcohol, and being a nonsmoker and nondrinker predicted quitting caffeine . Conclusions: The reasons for difficulty in quitting more than one substance are unknown but may include the difficulty of formulating appropriate beha vioral strategies or less concern about healthy behavior in pregnancy. Many women in the study successfully quit using two substances, however, and co unseling should focus on achieving that outcome.