The co-occurrence of maternal depressive symptoms and smoking in a national survey of mothers

Context.-Both maternal smoking and depression are common and can adversely impact child health and functioning, yet few studies have explored their co-occurrence among mothers. Objective.-To determine the prevalence and associations of depression and smoking among mothers in the United States. Design.-Random-digit-dial national telephone survey of 1530 households conducted in 2002. Respondents were asked about their sociodemographic characteristics, smoking status, and their children's receipt of Medicaid. A validated 3-item depression screen was administered. Bivariate and multiple regression analyses for maternal smoking and a positive depression screen were performed. Setting.-National sample. Participants.-Seven hundred two mothers with children aged less than 19 years living in their homes. Results.-The response rate was 61%. Among mothers, 24.3% were smokers, 24.4% had a positive depression screen, 8.1% had both, and 40.6% were smokers and/or had a positive depression screen. All rates were greater among mothers whose children receive Medicaid (37.6%, 47.5%, 20.6%, and 64.5%) than those whose children do not receive Medicaid (21.1% 19.0% 4.8%, and 35.3%) (P <.001) for each. In multivariate analyses, maternal smoking was independently associated with a 70% increased risk of depressive symptoms (odds radio, 1.7; 95% confidence interval, 1.1-2.6). Conclusions.-This study highlights both the frequency and the co-occurrence of maternal smoking and maternal depressive symptoms, two negative influences Oil children's health and development, as well as their increased prevalence among mothers whose children receive Medicaid, thereby highlighting the economic disparities associated with both. These findings have significant implications for our nation's children, health care clinicians, and health care payers.