Factors predicting pregnancy smoking in Southern Appalachia

OBJECTIVE: To examine sociodemographic, medical, and substance use factors associated with smoking continuation during pregnancy. METHODS: Data from 221 consecutive prenatal patients were analyzed. RESULTS: Of the 67% who were pre-pregnancy smokers (n=148), 27% quit during pregnancy, whereas another 43% reduced by > 1/4 pack/day. Women who continued to smoke had lower incomes, more prior pregnancies, were less likely to have adequate prenatal care, and smoked more and for more years than did women who quit during pregnancy. CONCLUSION: Several characteristics predicted pregnancy smoking in this sample. Results suggest ways to more effectively target pregnant women for successful smoking cessation.     

Predictors of smoking cessation during pregnancy among the women of Yamato and Ayase municipalities in Japan

Cigarette smoking during pregnancy affects the unborn fetus. This study aimed to investigate: (1) the smoking status of pregnant women before, during and after pregnancy in the Yamato and Ayase municipalities, Kanagawa, Japan; (2) the characteristics that differentiate successful spontaneous smoking quitters from continuous smokers during pregnancy; and (3) the awareness of risks of smoking that may influence smoking cessation during pregnancy. A community-based, cross-sectional survey of 420 postpartum women, who delivered their babies from July 2002 to October 2002, was performed. Out of 420 respondents, 275 (65.4%) did not smoke before and during pregnancy. Of the 145 women who smoked before pregnancy, 101 (69.3%) quit successfully while pregnant. Smoking prevalence during pregnancy was 10.4%. Out of 101 successful quitters during pregnancy, 22 (21.8%) women resumed smoking after childbirth. A multiple regression analysis showed that the independent predictors of smoking cessation during pregnancy were primiparous women and women living with non-smokers in the household. Although maternal age predicted smoking cessation in a simple regression analysis, this predictive value was lost in the multiple analysis. A simple analysis showed no significant association between the awareness of smoking risks and smoking cessation during pregnancy. It is suggested that Japanese smokers are more likely to quit while pregnant than women in other countries. In the future, smoking cessation programmes should be designed to help multiparous women and women living with smokers to give up smoking.     

Predictors of Smoking Cessation in Pregnancy and Maintenance Postpartum in Low-Income Women

Objective: To describe factors associated with smoking status of low-income women during pregnancy and postpartum. Methods: Data from a randomized clinical trial were used to conduct separate analyses on 327 women who smoked at baseline (time at enrollment) and for whom smoking status was available at delivery, and on 109 women who reported not smoking at delivery (quit spontaneously or after study enrollment) and for whom smoking status was available at 6-months postpartum. Salivary cotinine was used to assess the accuracy of self-reported smoking status for the sample as a whole. Data were collected between May 1997 and November 2000. Results: 18% of the 327 baseline smokers stopped smoking before delivery. Cessation was less likely in older women, those reporting Medicaid coverage (vs. commercial or no insurance), who were at a later week of pregnancy at baseline, were more addicted, had a husband/partner who smoked, and did not receive the study intervention. 37% of the 109 women who reported not smoking at delivery maintained abstinence at 6-months postpartum. Factors associated with abstinence were later week of pregnancy at baseline and quitting spontaneously with pregnancy, while women who lived with a smoker were less likely to report abstinence. Spontaneous quitters were less likely to relapse by 6 months postpartum than women who quit smoking later in pregnancy. Conclusions: Partner participation in smoking cessation programs for pregnant and postpartum women merits exploration. Lower relapse rates among spontaneous quitters indicate a need to foster an environment that encourages quitting at pregnancy.     

Breastfeeding duration and perinatal cigarette smoking in a population-based cohort

OBJECTIVES: We examined the association between breastfeeding duration and maternal smoking before, during, and after pregnancy. METHODS: Data from the 2000-2001 Oregon Pregnancy Risk Assessment Monitoring System were used. Early weaning was defined as not breastfeeding at 10 weeks postpartum. RESULTS: At 10 weeks after pregnancy, 25.7% of mothers who initiated breastfeeding no longer breastfed. After controlling for confounders, quitters (mothers who quit smoking during pregnancy and maintained quit status after pregnancy) and postpartum relapsers (mothers who quit smoking during pregnancy and resumed smoking after delivery) did not have significantly higher risk for early weaning than nonsmokers. However, persistent smokers (mothers who smoked before, during, and after pregnancy) were 2.18 times more likely not to breastfeed at 10 weeks (95% confidence interval=1.52, 2.97). Women who smoked 10 or more cigarettes per day postpartum (i.e., heavy postpartum relapsers and heavy persistent smokers) were 2.3-2.4 times more likely to wean their infants before 10 weeks than were nonsmokers. CONCLUSIONS: Maternal smoking is associated with early weaning. Stopping smoking during pregnancy and decreasing the number of cigarettes smoked postpartum may increase breastfeeding duration.     

Getting focused: missed opportunities for smoking interventions for pregnant women receiving Medicaid

BACKGROUND: The prevalence of smoking, and cessation and relapse rates for pregnant women have health and financial implications. Our objectives were to describe smoking among pregnant smokers receiving Medicaid including characteristics associated with reporting discussion of smoking with providers and the association between those discussions with quitting and maintenance. METHODS: Analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 15 states for 20,287 women with Medicaid for prenatal care during 1998-2000. RESULTS: Thirty-four percent of women smoked before pregnancy (N = 7,686). Most smokers (93%) and nonsmokers (88%) reported discussions about smoking during prenatal care. Women were less likely to have discussed smoking if they were lighter smokers (OR = 1.47; CI = 1.03, 2.12), or reported a previous low-birthweight infant (OR = 1.72; CI = 1.03-2.86). Women reporting discussions (compared to those not) were less likely to quit (ARR = 0.70: CI = 0.59-0.91). Quitters reporting discussions (compared to those not) were no more likely to maintain cessation (ARR = 0.89; CI = 0.7, 1.21). CONCLUSIONS: Smoking cessation interventions can be improved for pregnant women receiving Medicaid, especially if focused to address individual needs of light smokers, those with previous low-birthweight infants, or those who find it most difficult to quit.     

The sociodemographic predictors of smoking cessation among pregnant women in Canada

This study examined the sociodemographic predictors of smoking cessation attempts among pregnant women, and compared the characteristics of women who successfully quit smoking during pregnancy with those who relapsed before their child was born. Data, which were derived from the National Longitudinal Survey of Children and Youth, indicate that 23.7% of Canadian mothers smoked at some point during their pregnancies, of whom only 15.8% attempted to quit. Maternal and paternal education were the strongest predictors of successful cessation, whereas women pregnant with their first child, those who drank during pregnancy, and those who immigrated to Canada were the most likely to relapse. This study represents an important first step in identifying Canadian women at highest risk of sustained smoking during pregnancy, and is useful for the design of effective interventions, tailored to meet their needs.     

Effect of pregnancy on smoking behavior: a baseline study

The trend of increased smoking among young women has leveled off, yet 22 to 28 percent of pregnant women smoke. Aside from the usual risks of smoking, these women expose their fetuses to increased risk when they are pregnant. Pregnancy may motivate women to stop smoking because of potential adverse effects on their babies' health. A public health survey supported this claim, but no family practice studies have been reported. This is a retrospective study describing women's smoking behavior during pregnancy and at least six months after delivery. Self-administered questionnaires were given to 66 women in three family practices. Women were questioned regarding the number of cigarettes smoked before and during pregnancy and were asked their current level of smoking. Twelve women (18 percent) stopped smoking completely during pregnancy; however, of these 12, only seven (11 percent) were still not smoking at the time of the survey. Twenty-eight women (42 percent) cut down their smoking at least one-half pack per day during pregnancy. Six months to five years after delivery, only 18 of these 28 women were still smoking at least one-half pack per day less. Further study is needed to determine whether intensive antismoking efforts during routine prenatal care would be more effective and long-lasting.     

Maternal Smoking and the Timing of WIC Enrollment

Objective: To investigate the association between the timing of enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and smoking among prenatal WIC participants. Methods: We use WIC data from eight states participating in the Pregnancy Nutrition Surveillance System (PNSS). We adjust the association between the timing of WIC participation and smoking behavior with a rich set of maternal characteristics. Results: Women who enroll in WIC in the first trimester of pregnancy are 2.7% points more likely to be smoking at intake than women who enroll in the third trimester. Among participants who smoked before pregnancy and at prenatal WIC enrollment, those who enrolled in the first trimester are 4.5% points more likely to quit smoking 3 months before delivery and 3.4% points more likely to quit by postpartum registration, compared with women who do not enroll in WIC until the third trimester. However, among pregravid smokers who report quitting by the first prenatal WIC visit, first-trimester enrollment is associated with a 2% point increase in relapse by postpartum registration. These results differ by race/ethnicity; white women who enroll early are 3.6% points more likely to relapse, while black women are 2.5% points less likely to relapse. Conclusions: Early WIC enrollment is associated with higher quit rates, although changes are modest when compared to the results from smoking cessation interventions for pregnant women. Given the prevalence of prenatal smoking among WIC participants, efforts to intensify WIC’s role in smoking cessation through more frequent, and more focused counseling should be encouraged.     

Postpartum return to smoking among usual smokers who quit during pregnancy

BACKGROUND: Many women stop smoking while they are pregnant, but the majority resume smoking in the postpartum. The objective is to describe postpartum tobacco use of women who quit during pregnancy and factors predicting postpartum smoking relapse. METHODS: Secondary analysis of two surveys of new mothers. Survey A conducted in three maternity hospitals, including 685 women interviewed after birth and who answered a postal questionnaire at 5 months postpartum; survey B conducted in four 'départements' (administrative areas), including 636 women who answered a postal questionnaire at 6 months postpartum. Response rates were respectively 90% and 68%. Smoking status was recorded for three time periods: before pregnancy, during pregnancy, and at 5-6 months. Social characteristics and preventive behaviour were compared for regular smokers who had quit smoking during pregnancy and those who had not, and among quitters, who had resumed smoking postpartum and those who had not. RESULTS: In survey A, 37% were smokers before pregnancy, 34% of them stopped during pregnancy, and among the latter, 48% had resumed smoking 5-6 months after delivery. In survey B, the percentages were respectively 43, 54 and 57%. The most predictive factor of postpartum smoking relapse was the partner's smoking behaviour. CONCLUSION: Return to smoking after delivery is frequent, but nearly half of the regular smokers who had stopped during pregnancy were still non-smokers 5-6 months after the birth. However, to increase this proportion, interventions need to include partners, especially if they are smokers.     

Demographics and cigarette smoking among women

BACKGROUND. A population-based sample of 893 white women ages 25 to 59 years from five San Francisco, California, Bay Area counties were queried about their demographic characteristics, height, reported weight at age 25, cigarette smoking history, and oral contraceptive and sunscreen use. METHODS. Multiple logistic regression techniques were used to analyze the data. Forty-three percent of the women in the sample had never smoked more than 100 cigarettes, while 27% were current and 30% were former smokers. Separated or divorced women were more likely to have ever smoked. RESULTS. Women who were less educated, single, separated, or divorced or had smoked between 10 and 30 cigarettes per day were less likely to quit smoking. Women with less education and a longer history of smoking smoked more cigarettes per day. Women who had never smoked were more likely to use sunscreen and to report their weight as slightly less at age 25 than were smokers.     

Intention to breastfeed and other important health-related behaviour and beliefs during pregnancy

BACKGROUND: It is widely accepted that breastfeeding is the best form of infant feeding for the first 4-6 months of life. OBJECTIVE: This study explored whether intention to breastfeed is associated with other positive maternal health-related behaviours and beliefs during pregnancy. METHOD: A cross-sectional survey was carried out with 789 women attending antenatal clinics at Leicester Royal Infirmary NHS Trust. A structured questionnaire assessed feeding intention, use of folic acid, vitamin and iron supplementation, smoking status, smoking stage of change, and fetal health locus of control during pregnancy. RESULTS: Forty percent of the women stated that they intended to breastfeed exclusively, 27% planned to bottle feed, 23% intended to combine breast and bottle feeding and 10% were undecided. Women planning to breastfeed (either exclusively or in combination with bottle feeding) were more likely than those with alternative feeding plans to: have increased their folic acid intake, taken vitamin/iron supplements and have a primarily internal locus of control (perceive themselves to have control over the health of their unborn baby). Women intending to breastfeed were also less likely to smoke. Of the women who did smoke, those planning to breastfeed were more likely to be either considering or preparing to quit smoking during their pregnancy. CONCLUSION: In addition to educating pregnant smokers about the risks of maternal smoking, primary health care practitioners could also usefully address their knowledge, health beliefs and feeding intentions during antenatal care.     

Prenatal smoking cessation among Black and White women in Eastern North Carolina

PURPOSE: Limited information is available about Black:White disparities in prenatal smoking cessation, and the results of prior research are inconsistent. We analyzed smoking cessation and factors associated with cessation (attitudes, environment, and nicotine addiction) in a sample of pregnant Black and White women. METHODS: Women were interviewed at the first prenatal visit at two hospital-based clinics. RESULTS: Among former and current smokers, there were no significant differences in the percentage of former smokers between Black (46.8%) and White (43.3%) pregnant women, or in the percentage of "spontaneous quitters" (i.e., those who quit after learning that they were pregnant) for Blacks (36%) and Whites (28%). Both Black and White spontaneous quitters had evidence of occasional relapses to smoking. For Black and White women, smoking more than a pack a day prior to pregnancy was associated with smoking during pregnancy. DISCUSSION: Among current and former smokers, spontaneous cessation was about the same for Black and White women, and about two thirds of women who were smokers when they learned of the pregnancy continued to smoke during pregnancy. Nicotine addiction contributed to continued smoking.     

Prevalence of cigarette smoking in pregnant women participating in the special supplemental nutrition programme for Women,Infants and Children (WIC) in Minneapolis and Saint Paul,Minnesota, USA

Several adverse birth outcomes are associated with cigarette smoking. It is important to determine the prevalence of cigarette smoking among pregnant low-income women and to evaluate their smoking cessation patterns in order to target appropriate interventions. Ethnically diverse pregnant women aged 15-45 years were recruited from Minneapolis or Saint Paul Women, Infants, and Children (WIC) clinics before their third trimester. Serum cotinine levels were assayed for 98 women and compared with self-report. The women were unaware that their smoking status would be validated. Twenty-one (21%) women had a positive serum cotinine value (> or =3 ng/mL); 16 (76%) admitted smoking within the previous 24 h before interview and five denied smoking. Of the five, four had cotinine levels that could suggest passive smoke exposure. Thirty-seven women (38%) admitted cigarette smoking during the pregnancy but before knowing that they were pregnant; 18 (49%) of these denied current smoking at the interview and also presented with negative cotinine levels. These data suggest that some participants in WIC make a concerted effort to quit smoking when they find out they are pregnant, and are generally truthful when reporting their smoking habits during pregnancy.     

Trends in smoking before,during, and after pregnancy in ten states

BACKGROUND: While trends in smoking prevalence during pregnancy are known, little is known about trends in quitting during pregnancy and resuming smoking after pregnancy. OBJECTIVES: This study examined the trends in and correlates of quitting during pregnancy and resuming smoking after pregnancy. METHODS: We used population-based random surveys of recent mothers in ten U.S. states (total of 115,000 women) conducted between 1993 and 1999. RESULTS: Although the prevalence of smoking 3 months before pregnancy was stable at around 26%, quitting during pregnancy rose from 37% to 46% between 1993 and 1999. Adjusted for maternal and state characteristics, the odds of quitting during pregnancy increased 51% between 1993 and 1999 (odds ratio [OR]=1.51; 95% confidence interval [CI]=1.08-2.12). Approximately half of the women who quit smoking during pregnancy resumed smoking within 6 months postpartum. Primiparous, privately insured, college-educated women are more likely to quit and least likely to resume smoking after delivery, compared to multiparous, Medicaid-insured, and high school-educated women. Teenaged women are more likely to quit, but also more likely to resume smoking than older women. CONCLUSIONS: The increase in quit rates during pregnancy is encouraging, but the lack of any change in smoking before pregnancy or in postpartum relapse rates suggests that permanent changes in maternal smoking will require additional focus.     

Factors Associated With Quitting Smoking During Pregnancy Among Women Veterans

IntroductionLittle is known about the rates of smoking among pregnant veterans. Our objective was to examine rates of smoking during pregnancy and factors associated with quitting smoking during pregnancy.MethodsWe used data from a cohort study of pregnant veterans from 15 Veterans Health Administration facilities nationwide. Veterans who reported smoking during pregnancy were included in this analysis. Poisson regression models were used to estimate the relative risk (RR) of quitting smoking during pregnancy.ResultsOverall, 133 veterans reported smoking during pregnancy. Among this group of women who smoked, the average age was 31.6 years, 20% were Black, and 14% were Hispanic/Latino. More than one-half of women (65%) who reported smoking at the start of pregnancy quit smoking during pregnancy. Multivariable models, adjusted for history of deployment and age, indicated that prenatal care initiation at 12 or fewer weeks compared with more than 13 weeks (relative risk [RR], 2.06; 95% confidence interval [CI], 1.18–3.58), living without household smokers compared with any household smokers (RR, 1.58; 95% CI, 1.14–2.17), and first pregnancy (RR, 1.51; 95% CI, 1.17–1.95) were significant predictors of quitting versus persistent smoking during pregnancy.ConclusionsWomen veterans who quit smoking may be different than those who continue to smoke during pregnancy. Establishing prenatal care early in pregnancy, which likely includes counseling about smoking cessation, seems to be an important factor in quitting. Those for whom it is not a first pregnancy and who live with other smokers may especially benefit from such counseling.     

Slight decrease in the prevalence of smoking around pregnancy

OBJECTIVE: To establish smoking prevalence of fertile-aged women; before and during pregnancy, and 6 months after delivery. DESIGN: Cross-sectional. METHOD: Yearly surveys by questionnaires handed out during 2001-2003 to mothers visiting a Well Baby Clinic with infants aged 0-6 months. RESULTS: Out ofa total of 14,540 questionnaires, 9133 (63%) were completed and returned. Before pregnancy 25% of all the women concerned smoked, 6% stopped 6 months before getting pregnant; this percentage rose between 2001 (5%) and 2003 (7%). During pregnancy, 14% of the women smoked. This percentage was significantly lower in 2002 and 2003 (13%) compared to 16% in 2001. 11% smoked while pregnant (average 5 cigarettes daily), and 3% stopped some time during pregnancy. Of the mothers who quitted smoking before or during pregnancy, two thirds did so permanently. Nevertheless 15% of all women smoked during the first half year after delivery. This percentage was lowest in 2003 (14%) and highest in 2001 (17%). 28% of all mothers with infants aged 0-6 months had partners who smoked (daily 10 cigarettes average), these women were more likely to start smoking again (RR: 2). CONCLUSION: Minor positive changes were observed within the study period. A smoking partner contributed to smoking relapse after delivery.     

The effects of maternal smoking, physical stature, and educational attainment on the incidence of low birth weight

Data from the 1980 National Natality Survey were used to investigate the effects of maternal smoking, height, weight, and educational attainment on the incidence of low birth weight among white non-Hispanic married mothers aged 20-34 years, live birth order 1-3. Using multiple logistic regression to control for the effects of infant's sex, live birth order, and maternal age, women with less than 12 years education have a low birth weight odds ratio of 2.38 and women with 12 years have a low birth weight odds ratio of 1.24 relative to women with 13 or more years. After further controlling for height, weight, and smoking, these odds ratios are reduced to 1.59 and 1.11, respectively. The majority of the reduction can be attributed to differences in smoking among the education groups. Women with low education are more likely to have smoked prior to pregnancy, more likely to smoke heavily, and less likely to stop smoking during pregnancy. The odds of low birth weight increases by 26% for every five additional cigarettes smoked per day. If all women in the study population stopped smoking during pregnancy, the incidence of low birth weight would be expected to decline by 35% for those with less than 12 years education, by 20% for those with 12 years, and by 11% for those with more than 12 years. The effects of the independent variables were also estimated for two components of low birth weight: below 2,000 grams and 2,000-2,499 grams. Although the nonresponse rate for the National Natality Survey was 20%, a comparison of mail and telephone respondents suggests that the impact of nonresponse on the estimates of the logistic coefficients is minimal.     

Does parental smoking cessation discourage adolescent smoking?

BACKGROUND: We examined the relationship of smoking cessation in parents to smoking and uptake and cessation by their adolescent children. METHODS: We analyzed a cross-sectional sample of 4,502 adolescents, ages 15-17 years, who lived in two-parent households that were interviewed as part of the 1992-1993 Tobacco Supplement of the Current Population Survey, which questioned householders 15 years of age and older about their smoking history. Ever smokers reported smoking at least 100 cigarettes in their lifetime. Former smokers were ever smokers who had quit. RESULTS: Multivariate analyses, adjusted for demographic characteristics of adolescents, as well as father's age, education, and family income, found that adolescents whose parents had quit smoking were almost one-third less likely to be ever smokers than those with a parent who still smoked. Furthermore, adolescent ever smokers whose parents quit smoking were twice as likely to quit as those who had a parent who still smoked. Parental quitting is most effective in reducing initiation if it occurs before the child reaches 9 years of age. CONCLUSION: Encouraging parents to quit may be an effective method for reducing adolescent smoking, through decreased uptake and increased cessation. The earlier parents quit, the less likely their children will become smokers.