Multiple Social Demographics and Disparities in Smoking Cessation During Pregnancy in the United States, 2016-2022: An Intersectional Analytic Framework

Abstract

Objectives. To examine how multiple social demographics shape disparities in smoking cessation during pregnancy in an intersectional analytic framework. Methods. We analyzed US National Vital Statistics System (2016-2022) data on 588 435 primiparous women with prepregnancy smoking. We constructed 192 intersectional strata to represent contexts defined by race/ethnicity, education, marital status, insurance status, and immigration status. We conducted a multilevel analysis of individual heterogeneity and discriminatory accuracy to estimate intersectional inequities in smoking cessation during pregnancy, predict cessation prevalence across strata, and assess the extent to which disparities were attributable to additive or interaction effects. Results. Smoking cessation during pregnancy prevalence ranged from 27.2% to 89.4% across strata. Differences between intersectional strata explained 11.9% of the variation in smoking cessation, with educational level contributing most. Of the between-strata variation, 93.9% was explained by additive effects, whereas 6.1% was attributable to interaction effects. Conclusions. Significant disparities in pregnancy smoking cessation are linked to multiple social demographics, highlighting the need for universal interventions paired with tailored support for disadvantaged groups to advance maternal health equity. (Am J Public Health. 2025;115(11):1922-1932. https://doi.org/10.2105/AJPH.2025.308237).