Further Validation of the Religious Surrender and Attendance Scale-3 (RSAS-3).

Background: The Religious Surrender and Attendance Scale -3 (RSAS-3) is a very brief measure used to quantify religious commitment as a protective health factor.Methods: To provide evidence of criterion-related validity of the RSAS-3, 440 community members and undergraduate students completed a survey containing three religiosity measures: the RSAS-3, the Intrinsic/Extrinsic Orientation scale, and the Belief into Action scale (BIAC), and a measure of problematic substance use, Texas Christian University Drug Screen-5. It was hypothesized all religiosity measures would be positively interrelated, the measure of problematic use would be negatively related to all religiosity measures, and that the RSAS-3 would be strongly predictive of absence of problematic substance use. After data filtering and imputation, bivariate correlations were calculated to establish convergent validity.Results: All relationships were in the predicted directions. Specifically, BIAC had the strongest relationship with the RSAS-3, r (440) = .906, p < .001, followed by intrinsic religiosity, r (440) =.814, p < .001, and extrinsic religiosity, r (440) = .694, p < .001. The RSAS-3 was the strongest predictor of problematic use among the religiosity measures, r (440) = -0.230, p <.001. Criterion-related validity of the RSAS-3 was supported using logistic regression to explore intrinsic religiosity, extrinsic religiosity, BIAC, and RSAS-3 as predictors of the presence/absence of problematic substance use. The RSAS-3 was the only significant predictor (OR = .858 [95% CI .757 - .973], p = .017).Conclusion: All results provide further evidence for the validity of the RSAS-3 as a very brief measure of religious commitment useful in health settings.

Prevalence of Opioid Use and Intimate Partner Violence among Pregnant Women in South-Central Appalachia, USA.

Background: Recent research indicates that pregnant women in rural communities are at increased risk of experiencing IPV and comorbid illicit opioid use compared to urban-residing pregnant women. Few studies of the interactions among rurality, substance use, and victimization in pregnant women exist. The current study sought to examine the relationship between IPV and opioid use and the interaction effects of rurality in Appalachian pregnant women. Methods: A convenience sample of pregnant women who were enrolled in a smoking cessation research study was used for this analysis. Participants included 488 pregnant women from five prenatal clinics in South-Central Appalachia. Data were from self-reported assessments and semi-structured interviews on substance use and IPV conducted from first trimester of pregnancy through eight months postpartum. Results: Four hundred and ten participants reported experiencing any form of IPV in the past year. Logistic regression results indicated that physical IPV was associated with opioid use, but sexual and psychological IPV were not. The moderation model indicated direct effects between IPV and opioid use, but were not moderated by rurality. Conclusion: This study suggests a need to further understand the relationship between substance use, IPV, and rurality in pregnant women. The specific subtopic of opioid use by pregnant women living in rural communities, and its relationship to IPV victimization and adverse fetal and maternal health outcomes, continues to be an understudied, but critically important area. Limitations and future directions pertaining to IPV screenings and interventions for pregnant women are discussed.

Correction and Accuracy of PurpleAir PM2.5 Measurements for Extreme Wildfire Smoke.

PurpleAir particulate matter (PM) sensors are increasingly used in the United States and other countries for real-time air quality information, particularly during wildfire smoke episodes. Uncorrected PurpleAir data can be biased and may exhibit a nonlinear response at extreme smoke concentrations (>300 µg/m3). This bias and nonlinearity result in a disagreement with the traditional ambient monitoring network, leading to the public's confusion during smoke episodes. These sensors must be evaluated during smoke-impacted times and then corrected for bias, to ensure that accurate data are reported. The nearby public PurpleAir sensor and monitor pairs were identified during the summer of 2020 and were used to supplement the data from collocated pairs to develop an extended U.S.-wide correction for high concentrations. We evaluated several correction schemes to identify an optimal correction, using the previously developed U.S.-wide correction, up to 300 µg/m3, transitioning to a quadradic fit above 400 µg/m3. The correction reduces the bias at each air quality index (AQI) breakpoint; most ambient collocations that were studied met the Environmental Protection Agency's (EPA) performance targets (twelve of the thirteen ambient sensors met the EPA's targets) and some smoke-impacted sites (5 out of 15 met the EPA's performance targets in terms of the 1-h averages). This correction can also be used to improve the comparability of PurpleAir sensor data with regulatory-grade monitors when they are collectively analyzed or shown together on public information websites; the methods developed in this paper can also be used to correct future air-sensor types. The PurpleAir network is already filling in spatial and temporal gaps in the regulatory monitoring network and providing valuable air-quality information during smoke episodes.

Assessing Religious Commitment and Satisfaction: The Religious Surrender and Attendance Satisfaction Scale.

Survey instruments have been developed to measure whether someone claims to be religious but do not address the degree to which someone is satisfied with their religious commitment. The Religious Surrender and Attendance Satisfaction Scale (RSASS) was revised to measure both a person's level of religious commitment and satisfaction with level of religious commitment. This study was conducted to determine initial validity for the satisfaction portion of the RSASS. Construct validity measures provided initial confirmation of the utility of RSASS as a measure of satisfaction with religious commitment, that can be used by nurses in practice and research.

Advancing our understanding of religion and spirituality in the context of behavioral medicine.

Recognizing and understanding the potentially powerful roles that religiousness and spirituality (RS) may serve in the prevention and amelioration of disease, as well as symptom management and health related quality of life, significantly enhances research and clinical efforts across many areas of behavioral medicine. This article examines the knowledge established to date and suggests advances that remain to be made. We begin with a brief summary of the current knowledge regarding RS as related to three exemplary health conditions: (a) cardiovascular disease; (b) cancer; and, (c) substance abuse. We then focus on particular concerns for future investigations, emphasizing conceptual issues, possible mediators and moderators of relationships or effects, and methodology. Our discussion is framed by a conceptual model that may serve to guide and organize future investigations. This model highlights a number of important issues regarding the study of links between RS and health: (a) RS comprise many diverse constructs, (b) the mechanisms through which RS may influence health outcomes are quite diverse, and (c) a range of different types of health and health relevant outcomes may be influenced by RS. The multidimensional nature of RS and the complexity of related associations with different types of health relevant outcomes present formidable challenges to empirical study in behavioral medicine. These issues are referred to throughout our review and we suggest several solutions to the presented challenges in our summary. We end with a presentation of barriers to be overcome, along with strategies for doing so, and concluding thoughts.

Low-Cost Air Quality Monitoring Tools: From Research to Practice (A Workshop Summary).

In May 2017, a two-day workshop was held in Los Angeles (California, U.S.A.) to gather practitioners who work with low-cost sensors used to make air quality measurements. The community of practice included individuals from academia, industry, non-profit groups, community-based organizations, and regulatory agencies. The group gathered to share knowledge developed from a variety of pilot projects in hopes of advancing the collective knowledge about how best to use low-cost air quality sensors. Panel discussion topics included: (1) best practices for deployment and calibration of low-cost sensor systems, (2) data standardization efforts and database design, (3) advances in sensor calibration, data management, and data analysis and visualization, and (4) lessons learned from research/community partnerships to encourage purposeful use of sensors and create change/action. Panel discussions summarized knowledge advances and project successes while also highlighting the questions, unresolved issues, and technological limitations that still remain within the low-cost air quality sensor arena.

RSAS-3: validation of a very brief measure of Religious Commitment for use in health research.

Religious Commitment is a construct known to be predictive of various health-related factors of importance to researchers. However, data collection efficiency and instrument brevity in healthcare settings are priorities regardless of the construct being measured. Brief, valid instruments are particularly valuable in health research and will be vital for testing mechanisms by which health may be improved or maintained. This series of studies aims to demonstrate that Religious Commitment can be validly measured with a very brief instrument, the Religious Surrender & Attendance Scale-3 (RSAS-3), which combines a 2-item measure of Surrender, a specific type of religious coping, with a 1-item measure of Attendance at religious services. Three studies are reported, two utilizing undergraduate university students (Ns = 964 and 466) and one utilizing a clinical-based pregnant population (N = 320), all in southern Appalachia. The original 12-item Surrender Scale, a 2-item subset of Surrender items, and Attendance were found to be highly positively correlated with each other and with Intrinsic Religiosity, an additional measure of Religious Commitment employed to demonstrate concurrent validity. Religiosity variables were found to be strongly negatively correlated with Anxiety and stress, which were the health outcomes of interest. Hierarchical multiple regression analysis was used to confirm the similarity of Anxiety and stress prediction using the 12-item and 2-item Surrender measures and to confirm the superior stress prediction of the 3-item instrument RSAS-3. The RSAS-3 is recommended as a measure of Religious Commitment in future health research.

The cognitive tasks and event-related potentials associated childhood adversity: A systematic review.

In this systematic review, 18 articles met inclusion criteria to be qualitatively analyzed for converging evidence of brain activity, measured using event-related potential (ERP), related to retrospectively reported childhood adversity/trauma. Using the PRISMA guidelines for systematic reviews, 917 articles were assessed for inclusion and were filtered using study parameters. The most common ERP components listed in the literature were P100, N170, N200, P200, P300, ERN, and LPP. We discuss levels of evidence for changed brain activity, each ERP component, and the tasks used to evoke them. The Childhood Trauma Questionnaire was found to be the most commonly cited measure. We note the need to assess the duration and intensity of childhood adversity/trauma measurements in the strengths and limitations of the reported childhood adversity/trauma measurements. No concrete converging evidence was found to support a relationship between ERP-measured brain activity and retrospectively reported childhood adversity/trauma. Thus, a discussion of limitations and future directions for this field of research is presented.

Salivary cortisol measurement in developmental research: where do we go from here?

Salivary cortisol has been measured extensively in developmental research over the last three decades. The purpose of this article is to summarize the contributions to and limitations of salivary cortisol measurement in developmental research and propose future directions for research that includes salivary cortisol measurement. The properties of cortisol, the history of its burgeoning popularity, and the utility and limitations of (a) cortisol as a biological indicator, (b) saliva as a source of cortisol, and (c) various saliva collection methodologies are described. The current state of understanding about what is and is not reliably predictable from cortisol is summarized and the value of salivary cortisol measurement in developmental research is discussed, addressing whether methodology could be driving research design. Recommendations are made for streamlining study design and reporting within developmental research.

Characterization of summertime coarse particulate matter in the Desert Southwest--Arizona, USA.

UNLABELLED: A year-long study was conducted in Pinal County, AZ, to characterize coarse (2.5 - 10 microm aerodynamic diameter, AD) and fine (< 2.5 microm AD) particulate matter (PMc and PMf, respectively) to further understand spatial and temporal variations in ambient PM concentrations and composition in rural, arid environments. Measurements of PMc and PMf mass, ions, elements, and carbon concentrations at one-in-six day resolution were obtained at three sites within the region. Results from the summer of 2009 and specifically the local monsoon period are presented. The summer monsoon season (July - September) and associated rain and/or high wind events, has historically had the largest number of PM10 NAAQS exceedances within a year. Rain events served to clean the atmosphere, decreasing PMc concentrations resulting in a more uniform spatial gradient among the sites. The monsoon period also is characterized by high wind events, increasing PMc mass concentrations, possibly due to increased local wind-driven soil erosion or transport. Two PM10 NAAQS exceedances at the urban monitoring site were explained by high wind events and can likely be excluded from PM10 compliance calculations as exceptional events. At the more rural Cowtown site, PM10 NAAQS exceedances were more frequent, likely due to the impact from local dust sources. PM mass concentrations at the Cowtown site were typically higher than at the Pinal County Housing and Casa Grande sites. Crustal material was equal to 52-63% of the PMc mass concentration on average. High concentrations of phosphate and organic carbon found at the rural Cowtown were associated with local cattle feeding operations. A relatively high correlation between PMc and PMf (R2 = 0.63) indicated that the lower tail of the coarse particle fraction often impacts the fine particle fraction, increasing the PMf concentrations. Therefore, reductions in PMc sources will likely also reduce PMf concentrations, which also are near the value of the 24-hr PM2.5 NAAQS. IMPLICATIONS: In the desert southwest, summer monsoons are often associated with above average PM10 (< 10 microm AD) mass concentrations. Competing influences of monsoon rain and wind events showed that rain suppresses ambient concentrations while high wind increase them. In this region, the PMc fraction dominates PM10 and crustal sources contribute 52-63% to local PMc mass concentrations on average. Cattle feedlot emissions are also an important source and a unique chemical signature was identified for this source. Observations suggest monsoon wind events alone cannot explain PM10 NAAQS exceedances, thus requiring these values to remain in compliance calculations rather than being removed as exceptional wind events.

An analysis of degradation in low-cost particulate matter sensors.

Low-cost sensors (LCS) are increasingly being used to measure fine particulate matter (PM2.5) concentrations in cities around the world. One of the most commonly deployed LCS is the PurpleAir with ~ 15,000 sensors deployed in the United States, alone. PurpleAir measurements are widely used by the public to evaluate PM2.5 levels in their neighborhoods. PurpleAir measurements are also increasingly being integrated into models by researchers to develop large-scale estimates of PM2.5. However, the change in sensor performance over time has not been well studied. It is important to understand the lifespan of these sensors to determine when they should be serviced or replaced, and when measurements from these devices should or should not be used for various applications. This paper fills this gap by leveraging the fact that: (1) Each PurpleAir sensor is comprised of two identical sensors and the divergence between their measurements can be observed, and (2) There are numerous PurpleAir sensors within 50 meters of regulatory monitors allowing for the comparison of measurements between these instruments. We propose empirically derived degradation outcomes for the PurpleAir sensors and evaluate how these outcomes change over time. On average, we find that the number of 'flagged' measurements, where the two sensors within each PurpleAir sensor disagree, increases with time to ~ 4% after 4 years of operation. Approximately 2 percent of all PurpleAir sensors were permanently degraded. The largest fraction of permanently degraded PurpleAir sensors appeared to be in the hot and humid climate zone, suggesting that sensors in these locations may need to be replaced more frequently. We also find that the bias of PurpleAir sensors, or the difference between corrected PM2.5 levels and the corresponding reference measurements, changed over time by -0.12 µg/m3(95% CI: -0.13 µg/m3, -0.10 µg/m3) per year. The average bias increases dramatically after 3.5 years. Further, climate zone is a significant modifier of the association between degradation outcomes and time.

Chemical speciation of PM2.5 and PM10 in south Phoenix, AZ, USA.

Phoenix, AZ, experiences high particulate matter (PM) episodes, especially in the wintertime. The spatial variation of the PM concentrations and resulting differences in exposure is of particular concern. In this study, PM2.s (PM with aerodynamic diameter <2.5 microm) and PM10 (PM with aerodynamic diameter <10 microm) samples were collected simultaneously from the east and west sides of South Phoenix and at a control site in Tempe and analyzed for trace elements and bulk elemental and organic carbon. Measurements showed that although PM2.5 concentrations had similar trends in temporal scale across all sites, concentrations of PM10 did not. The difference in PM10 concentrations and fluctuation across the three sites suggest effects of a local soil source as evidenced by high concentrations of Al, Ca, and Fe in PM10. K and anthropogenic elements (e.g., Cu, Pb, and Zn) in PM2.5 samples on January 1 were strikingly high, suggesting the influence of New Year's fireworks. Concentrations of toxic elements (e.g., Pb) in the study presented here are not different from similar studies in other U.S. cities. Application of principal component analysis indicated two broad categories of emission sources--soil and combustion--together accounting for 80 and 90% of variance, respectively, in PM2.5 and PM10. The soil and combustion components explained approximately 60 and 30% of the variance in PM10, respectively, whereas combustion sources dominated PM2.5 (>50% variance). Many elements associated with anthropogenic sources were highly enriched, with enrichment factors in PM2.5 an order of magnitude higher than in PM10 relative to surface soil composition in the study area.

Promoting the emergence of tacting three-digit numerals through a chain prompt combined with matrix training.

Children with autism spectrum disorder (ASD) have difficulty generalizing from directly trained responses to untrained responses (i.e., emergent responding). In this study, we used a chain prompt combined with matrix training to teach 2 participants with ASD to tact 192 three-digit numerals. We used a multiple-baseline design across matrices to evaluate the treatment effects on trained and untrained tacts of numerals. Both participants mastered all numerals exposed to training and all numerals not exposed to training after 3 to 5 sixteen-trial sessions per matrix. One participant learned to tact 8 numerals for each 1 numeral exposed to direct training, and the other participant learned to tact 12 numerals for each 1 numeral exposed to direct training. We discuss these results relative to the effectiveness and efficiency of our chain prompt combined with matrix training for teaching tacting skills for targets with shared stimulus properties that facilitate generalization to untrained targets.

Development and Application of a United States wide correction for PM2.5 data collected with the PurpleAir sensor.

PurpleAir sensors, which measure particulate matter (PM), are widely used by individuals, community groups, and other organizations including state and local air monitoring agencies. PurpleAir sensors comprise a massive global network of more than 10,000 sensors. Previous performance evaluations have typically studied a limited number of PurpleAir sensors in small geographic areas or laboratory environments. While useful for determining sensor behavior and data normalization for these geographic areas, little work has been done to understand the broad applicability of these results outside these regions and conditions. Here, PurpleAir sensors operated by air quality monitoring agencies are evaluated in comparison to collocated ambient air quality regulatory instruments. In total, almost 12,000 24-hour averaged PM2.5 measurements from collocated PurpleAir sensors and Federal Reference Method (FRM) or Federal Equivalent Method (FEM) PM2.5 measurements were collected across diverse regions of the United States (U.S.), including 16 states. Consistent with previous evaluations, under typical ambient and smoke impacted conditions, the raw data from PurpleAir sensors overestimate PM2.5 concentrations by about 40% in most parts of the U.S. A simple linear regression reduces much of this bias across most U.S. regions, but adding a relative humidity term further reduces the bias and improves consistency in the biases between different regions. More complex multiplicative models did not substantially improve results when tested on an independent dataset. The final PurpleAir correction reduces the root mean square error (RMSE) of the raw data from 8 µg m-3 to 3 µg m-3 with an average FRM or FEM concentration of 9 µg m-3. This correction equation, along with proposed data cleaning criteria, has been applied to PurpleAir PM2.5 measurements across the U.S. in the AirNow Fire and Smoke Map (fire.airnow.gov) and has the potential to be successfully used in other air quality and public health applications.

Initial Validation and Findings From the Willing/Ready Subscale of the Church Addiction Response Scale.

Addiction has been a global health crisis over recent decades and worsened substantially during COVID-19 lockdowns. We report on the development, validation, and findings from an instrument developed to assess the readiness of churches in the Appalachian Highlands to address addiction. The Church Addiction Response Scale (CARS) is a 41-item, three section measure assessing "What are your views about addiction?" (14 items), "What are your views about interacting with people who are addicted to drugs?" (11 items), and "What do you think the church's role is in addressing addiction?" (16 items). The CARS was found to be unidimensional with strong internal consistency and initial evidence of construct validity was positive. Most respondents reported willingness to assist people living with addiction, but many reported that they felt underprepared, thus were not ready. Areas of preparation were largely those that could be addressed through training, such as understanding the physiology and psychology of addiction, available treatment options, and how to avoid doing harm. Thus, with adequate training, the likelihood of equipping a church-based workforce to provide support for people living with addiction seems attainable.

Pocket ACE: Child sexual abuse survivors missed by the ACEs Study Questionnaire.

BACKGROUND: A 1998 seminal study catapulted adverse childhood experiences (ACEs) into the zeitgeist and shaped assessment of these experiences and long-term health consequences via The ACEs Study Questionnaire (ACE-SQ). However, the ACE-SQ's childhood sexual abuse (CSA) item requires the perpetrator have been 5-years or older than the survivor for endorsement. This may not adequately capture CSA and limit the questionnaire's ability to detect survivors. OBJECTIVE: This study assessed whether CSA survivors were missed by this 5-year modifier, whether service access was restricted, and whether those missed were at elevated risk for adverse outcomes. PARTICIPANTS AND SETTING: A sample of 974 women (Mage = 30.46) completed an online survey. METHODS: Histories of CSA were assessed using the original ACE-SQ and an alternative version without the 5-year modifier. Participants were grouped by endorsement (Modifier, No Modifier, No CSA) and compared across numerous physical and mental health outcomes using MANOVA, ANOVA, and logistic regression. RESULTS: Numerous CSA survivors are presently missed by the 5-year modifier (n = 118 of N = 249). This group demonstrated the same elevated depression (t = 3.44, p = .002, d = 0.34), heightened somatic symptom burden (t = 3.34, p = .003, d = 0.35), and poorer subjective health (t = -2.86, p = .012, d = 0.27) as those captured by the modifier. CONCLUSIONS: Recommendations for research, practice, and policy include removing the 5-year modifier from CSA assessment, creating an empirically informed CSA definition, and eliminating or adjusting requisite cut-scores for accessing services.

Using Trauma Informed Principles in Health Communication: Improving Faith/Science/Clinical Collaboration to Address Addiction.

Problematic substance use is a pressing global health problem, and dissemination and implementation of accurate health information regarding prevention, treatment, and recovery are vital. In many nations, especially the US, many people are involved in religious groups or faith communities, and this offers a potential route to positively affect health through health information dissemination in communities that may have limited health resources. Health information related to addiction will be used as the backdrop issue for this discussion, but many health arenas could be substituted. This article evaluates the utility of commonly used health communication theories for communicating health information about addiction in religious settings and identifies their shortcomings. A lack of trusting, equally contributing, bidirectional collaboration among representatives of the clinical/scientific community and religious/faith communities in the development and dissemination of health information is identified as a potential impediment to effectiveness. The Substance Abuse and Mental Health Services Administration's (SAMHSA) tenets of trauma-informed practice, although developed for one-on-one use with those who have experienced trauma or adversity, are presented as a much more broadly applicable framework to improve communication between groups such as organizations or communities. As an example, we focus on health communication within, with, and through religious groups and particularly within churches.

Prenatal substance use: Religious women report lower use rates, but do they use less?

An inverse relationship exists between self-reported religiousness and substance use. However, we question whether religious culture impacts the veracity of self-reported substance use. The primary aim of this study of low-income pregnant women in South Central Appalachia was to determine the accuracy of self-reported substance use in pregnant women as well as to determine whether there were differences in use rates and/or differences in the degree to which women would accurately report substance use depending on their religiousness. Self-reported use and toxicology screening results taken from a larger prospective, longitudinal, smoking cessation study were compared for five substances (cannabinoids [marijuana or other cannabinoids], benz/barb/sed [including benzodiazepines, barbiturates, or any sedative], opioids [including heroin, methadone or other medication-assisted treatment medications, or other opiates], crack/cocaine [crack or cocaine], and meth/amph [including methamphetamine or any other amphetamine]). Women who attend church frequently reported lower rates of substance use than infrequent or nonattenders, as did women who rated themselves as high in intrinsic religiosity (IR), although the difference between high and low groups is less extreme for IR as opposed to attendance. Women who attended church frequently were far less likely to report use or to have use confirmed than any of the other groups including those high in IR. Rates of positive toxicology screens did not differ statistically across religiousness groupings, but the pattern of proportionally fewer positive toxicology results was seen in frequent attenders but not in women self-reporting as high IR. Women's tendency to underreport substance use was unrelated to religiousness variables, indicating underreporting is not necessarily driving this difference in reported substance use.

Creating a Communitywide System of Trauma-Informed Care.

The past few decades of research support both the impact of trauma (e.g., abuse, neglect, violence) particularly in childhood, and the ability to lessen its effects through the implementation of trauma-informed care (TIC). We have successfully developed a communitywide system of TIC enhancing collaboration and common language across sectors and organizations within sectors. The collaboration involved more than 100 individuals from more than 45 organizations including healthcare, education, children's services, the faith community, behavioral health providers, criminal justice, law enforcement, private businesses, and others. The process for developing a system of care has been evaluated through community surveys and focus groups, verifying its ability to increase understanding and implementation of TIC principles, replication in a nearby city, and the development of an instructional toolkit to aid other communities in creating such systems of care.

Psychosocial well-being and efforts to quit smoking in pregnant women of South-Central Appalachia.

INTRODUCTION: Psychosocial well-being variables from the Tennessee Intervention for Pregnant Smokers (TIPS) study, a longitudinal smoking cessation study in South-Central Appalachia, were investigated as potential predictors of smoking status. METHODS: A sample of 1031 pregnant women participated in an expanded 5A's (Ask, Advise, Assess, Assist, Arrange) program, from 2008 to 2011. Measures of stress, self-esteem, depressive symptoms, and disordered eating collected by interview during the first trimester, or during the third trimester in a combined interview if participants began prenatal care late, were hypothesized to differ among three groups of participants: pregnant women who never smoked, pregnant women who smoked but quit prior to birth, and pregnant women who smoked and did not quit prior to birth. Smoking status was measured throughout the study. Whether or not a participant quit smoking was assessed at delivery. RESULTS: Non-smokers were lowest in stress F(2,1027) = 46.38, p < .001) and depression (F(2,1028) = 39.81, p < .001), and highest in self-esteem (F(2,1018) = 29.81, p < .001). Only self-reported stress and self-reported self-esteem predicted quitting. Higher reported stress levels were related to a slightly lower likelihood of quitting (OR = 0.95, 95% CI 0.92, 0.98, p = .003) and higher reported self-esteem predicted a slightly higher likelihood of quitting (OR = 1.05, 95% CI 1.02, 1.08, p = .001). CONCLUSIONS: Findings may lead to improved intervention programs and reduction of adverse health effects in children attributable to prenatal smoking. More research should be conducted on smoking cessation in rural pregnant women.