A reasoned action approach to pregnant smokers’ intention to switch to e-cigarettes: Does educational attainment influence theory application?

Social determinant research has noted educational attainment to be among the strongest influencing factors for tobacco use during pregnancy. Concurrently, maternal e-cigarette use has doubled in recent years, with some citing it as a safer alternative to combustible cigarettes. To better understand the decision-making practices of pregnant persons based on educational attainment, the reasoned action approach (RAA) was used to evaluate factors that may be associated with the intention to switch from cigarettes to e-cigarettes. A sample of U.S. pregnant persons (n = 267) between 18-40 years of age, who smoked at least one cigarette in the past 30 days, completed an online survey about switching from cigarettes to e-cigarettes. RAA constructs (e.g., intentions, instrumental attitudes, etc.) were measured using a pre-validated scale. Using structural equation modeling, the variability of latent variables (i.e., RAA constructs) and their interaction with one another were analyzed by educational attainment via two regression models: one for those who had college experience or had completed a college degree and another for those who had not attended college. Instrumental attitudes, experiential attitudes, and descriptive norms were significantly associated with intention to switch from cigarettes to e-cigarettes among both groups; however, autonomy was only significantly associated with intention among those who had not attended college. The RAA offers a valuable framework for understanding pregnant persons’ decision to switch from cigarettes to e-cigarettes during pregnancy; however, the RAA constructs may be related to intentions differently based on upstream factors, such as educational attainment.