Alexandra Houston-Ludlam

  • Lothian, Maryland

  • Maryland-College Park, U. of (2014)

  • Human and Statistical Genetics

  • Andrew C. Heath, D.Phil.

  • Neighborhood and individual influences on cigarette smoking during pregnancy.



My research project focuses on understanding risk prediction for cigarette smoking during pregnancy (SDP), with a focus on understanding neighborhood influences, variations in risk factors by maternal race/ethnicity, and achieving individual-level risk prediction. SDP has well-established negative health consequences for people who smoke during pregnancy and their offspring. Since most people who smoke during pregnancy are young, successful and permanent cessation by first pregnancy would achieve an important reduction in tobacco-related morbidity and mortality. Improving individual-level risk prediction is necessary to achieve greater and more equitable reductions in SDP. I use several difference approaches to this question. One, I use birth record data from Missouri, a state with the lowest tobacco taxes, few enacted tobacco control policies, and high rates of SDP, linked to publicly-available US Census/American Community Survey data via census tract, to understand individual-level predictors at the population level. Two, I use data from existing longitudinal research cohorts, including a female like-sex twin pair cohort (Missouri Adolescent Female Twin Study) and a high-risk family study of alcoholism and related conditions oversampled for Black/African American families (Missouri Family Study), to understand additional individual-level predictors available in these deeply-phenotyped cohorts. Lastly, I have initiated a pilot data collection of Native American women to examine the additional domains of traditional / ceremonial tobacco use and positive racial identity as protective factors for SDP for Indigenous women.


Thus far, I have identified that maternal sociodemographics at time of pregnancy are as strong a predictor of SDP as lifetime measures of Nicotine Dependence. Further, for people with low levels of nicotine dependence, risk for SDP is explained largely by maternal sociodemographic risk factors, highlighting need for improved provider-level assessment, intervention, and support for perinatal smoking cessation. When examining risk factors at the population level, the social influences of marital status/paternity affirmation and census tract-level smoking during pregnancy rate prove to be consistent predictors of individual-risk of smoking during first pregnancy, even after accounting robustly for individual and neighborhood-level characteristics.


Last Updated: 9/11/2017 12:12:47 PM

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