Purpose: The purpose of this study is to assess the attitudes, beliefs, perceptions, and practices regarding tobacco use and exposure among pregnant women in the Dominican Republic and determine if these are emerging public health issues.

Methods: This study used a mixed methods research design to assess the attitudes, beliefs, perceptions, and practices surrounding tobacco use and exposure using a systematic qualitative Rapid Assessment Procedure (semi-structured interviews, direct observations, and collection of documents and public health literature) and a secondary analysis of an existing quantitative database from a survey examining pregnant women's tobacco use, second-hand smoke exposure, knowledge about risks of smoking and benefits of quitting, and attitudes toward women's tobacco use in the Dominican Republic. All data were collected in the same public health hospitals in Santiago, Dominican Republic between April and August 2009.

Results: Findings from the qualitative data (n=28) suggests that respondents perceived an overall high prevalence of smoking in their respective communities, and a perceived increase in the prevalence of smoking among women. Although reference to the mandated general health warning ("Fumar es Prejuidicial para la Salud" – Smoking is harmful to your health) was common, knowledge of specific health risks related to smoking for both women and their unborn children was limited. Secondhand smoke exposure was frequent among respondents who reported being exposed to secondhand smoke by family members, spouses, friends, and/or neighbors. Respondents perceived only minimal advice from health care provider regarding tobacco use and exposure during pregnancy. The quantitative data (n=192) indicated that 5% (n=10) of pregnant women were ever regular smokers and among these ever regular smokers, half reported being current smokers (n=5) and half reported being ex-smokers (n=5). Among all women, 14% (N=26) reported experimenting with smoking and 6% (n=13) reported they would likely resume or begin smoking within the next year. Rates of self-reported secondhand smoke exposure among pregnant women were 31% (n=60) and over half reported their young children being exposed to secondhand smoke, 57% (N=26). Most of the pregnant women in this study allowed smoking in their home, 76% (N=146).

Conclusions: This study provides a preliminary understanding of tobacco use and exposure among pregnant women, and its potential impact on the Dominican Republic's public health efforts that include improving maternal and child health. Data from this study suggests that tobacco use and exposure among pregnant women in the Dominican Republic are emerging public health problems and further research is needed.