Context: Rural Appalachian women living in poverty have a high prevalence of prenatal smoking; yet, few studies have examined this issue. Purpose: To investigate the demographic and psychosocial characteristics of prenatal smokers and nonsmokers in low-socioeconomic status, rural Appalachian 2-parent families. Methods: During an 18-month period, two thirds of eligible low-socioeconomic status prenatal patients were recruited for a longitudinal study from a community health clinic in a rural West Virginia county. Data for the present report are from 92 women with a husband/partner (37 smokers and 55 nonsmokers) who completed a prenatal interview in the last trimester of pregnancy. This interview included demographics, personality traits, self-esteem problems, social support, and marital/partner relationship. Findings: Compared to nonsmokers, prenatal smokers were less likely to have completed high school, less extroverted, and also had lower self-esteem, less intimate support, and more negative marital relationship. Conclusions: High school graduation and variables related to positive personality and supportive relationships distinguished smokers from nonsmokers. The causal relationship between these variables and prenatal smoking requires more work in larger and varied populations, and this study provides some direction for ongoing longitudinal investigation.