The purpose of this study was to apply the theory of planned behavior (TPB) to the intent to quit smoking among a Medicaid-supported cohort of maternity patients at the onset of care by identifying the predictors of the intention to quit smoking. This was a secondary data analysis in which data collected during the six natural history studies of the Alabama Tobacco Free Families (ATOFF) program were used to generate and test an explanatory model for intention to quit smoking during pregnancy. The model included three of the TPB constructs (attitude, perceived behavioral control, and intention) and three additional variables (past behavior, ETS exposure, and anti-smoking mass media exposure). The TPB construct subjective norm was not available in the ATOFF data. Participants for this study were 585 new maternity patients (Research Question 1) who were self-reported smokers and 484 self-reported smokers (Research Question 2) among the same maternity population who had been exposed to an antismoking media campaign. Descriptive statistics and other quantitative measures were used to identify the predictors of intention and to explore correlational associations among them.

The findings of this study did not support the use of TPB as a conceptual framework for predicting cognitive determinants of a pregnant smoker's intention to quit smoking due to the retrospective application of the theory. However, an examination of the associations among the determinants was possible. Statistically significant associations between attitude, perceived behavioral control and intention were established. When added to the TPB model, a statistically significant association between exposure to ATOFF's anti-smoking mass media campaign and intention was not clearly seen. This may have been due to limitations of the TV and radio coverage areas. Among the TPB constructs, perceived behavioral control was found to be the construct most strongly associated with intention. When the associations were examined further, exposure to antismoking mass media, past smoking behavior, and ETS exposure were found to be statistically significantly associated with attitude. Exploring the predictors of the intention to quit smoking may aid researchers in developing cessation programs that are more effective in motivating pregnant women to quit smoking.