Smoking during pregnancy among northwest Native Americans.

There is little available information on the smoking habits of Native Americans. The authors used data from the Washington State birth certificate to determine the prevalence of smoking during pregnancy among Native American mothers in Washington State. From 1984 through 1988, 39.8 percent of all Native Americans smoked during their pregnancy. Smoking patterns during pregnancy differed markedly between Native Americans and whites according to maternal age and marital status. The smoking prevalence in Native Americans, adjusted for maternal age and marital status, was 1.3 times higher than that found in Washington State white women. This is the first analysis of statewide smoking rates during pregnancy among Native Americans. The birth certificate can serve as a readily accessible and low cost surveillance system for populations such as Native Americans, who are otherwise difficult to study. Smoking intervention programs need to be targeted at Native Americans, and how their smoking patterns differ from those of the general population needs to be recognized.     

Smoking during pregnancy, 1967-80.

Data from two national samples of live births to married mothers (the 1967 and 1980 National Natality Surveys) were used to document changes in smoking during pregnancy. Smoking among married teenagers remained essentially constant between 1967 and 1980. For married mothers age 20 and over, the prevalence of smoking during pregnancy decreased from 40 to 25 per cent among Whites and 33 to 23 per cent among Blacks. There were striking differences in the magnitude of the decrease by educational attainment. Among the White married mothers age 20 and over, the prevalence of smoking during pregnancy decreased from 48 to 43 per cent for those with less than 12 years education and from 34 to 11 per cent for those with 16 or more years education.     

Smoking before, during, and after pregnancy.

We report the first national data on smoking before, during, and after pregnancy. Estimates are based on the 1986 Linked Telephone Survey that reinterviewed 1,550 White women 20-44 years of age who were respondents to the 1985 National Health Interview Survey. An estimated 39 percent of White women who had smoked before pregnancy quit smoking while pregnant (27 percent when they found out they were pregnant and 12 percent later during pregnancy). Women with less than 12 years of education were five times as likely to smoke and one-fourth as likely to quit as those with 16 or more years of education. Women who smoked more than one pack of cigarettes per day before pregnancy were one-fifth as likely to quit as those smoking less. Of the women who quit, 70 percent resumed smoking within one year of delivery. Of those who relapsed, 67 percent resumed smoking within three months of delivery and 93 percent within six months. There is little evidence of educational differentials in relapse rates. The fact that relapse remains high suggests that while health of the fetus is a strong influence on women's smoking habits, women may be less aware of the effect of passive smoke on the infant.     

Smoking during pregnancy--United States, 1990-2002

Cigarette smoking during pregnancy adversely affects the health of both mother and child. The risk for adverse maternal conditions (e.g., premature rupture of membranes, abruptio placentae, and placenta previa) and poor pregnancy outcomes (e.g., neonatal mortality and stillbirth, preterm delivery, and sudden infant death syndrome) is increased by maternal smoking. Infants born to mothers who smoke weigh less than other infants, and low birthweight (<2,500 grams) is a key predictor for infant mortality. Infertility and conception delay also might be elevated by smoking. National health objectives for 2010 target an increase in cessation to 30% among pregnant smokers during the first trimester and abstinence from cigarettes by 99% of women giving birth. To assess progress toward these goals, CDC analyzed state-specific trends in maternal smoking during 1990-2002 by using data collected on birth certificates. This report summarizes the results of those analyses, which indicated that whereas participating areas observed a significant decline in maternal smoking during the surveillance period, 10 states reported recent increases in smoking by pregnant teens. Although the widespread public health message to abstain from smoking during pregnancy has helped decrease maternal smoking, to reduce prevalence further, implementation of additional interventions are required.     

Smoking cessation and associated factors during pregnancy

OBJECTIVE: To examine smoking habits before and during pregnancy, as well as factors associated with smoking cessation, in three European settings. METHODS: Women seeking antenatal care in Ashford (UK), Minorca and Barcelona (Spain) were recruited to the Asthma Multicenter Infant Cohort Study (AMICS). Questionnaires inquiring into the smoking habits of each woman and her partner, demographic data, occupation, educational level, number of previous children, breast feeding, alcohol intake, and history of asthma and of other allergic diseases were completed during pregnancy and in the first year after delivery. RESULTS: A total of 1,572 pregnant women were included in the three cohorts. Smoking prior to pregnancy was more common in Barcelona (46.2%) than in Minorca (39.8%) or Ashford (31.6%). Cessation rates during pregnancy also differed: 18% of women in Ashford, 20.4% in Minorca and 31.9% in Barcelona were still smoking during the first trimester. In a multivariate regression model, the factors showing a significant (negative) association with smoking cessation during pregnancy were having older children, having a partner who smoked and starting smoking at a young age. CONCLUSIONS: Baseline smoking habits and changes in smoking habits during pregnancy significantly differed between the three communities studied. Women pregnant with their first child, those who had started smoking at a later age and those whose partners were non-smokers were more likely to stop smoking when pregnant.     

Smoking during pregnancy: Missouri longitudinal study

Maternal smoking during pregnancy has been shown to be associated with reduced birthweight and increased fetal and infant mortality. This paper examines these patterns in first and second maternally-linked singleton pregnancies from 1978 to 1990 among 176 843 Missouri resident women with known smoking status in both pregnancies. Generally women were more likely to smoke in their second pregnancies (27.4%), than in their first (25.8%). This pattern was strongest among those whose first pregnancies occurred as teenagers, and for black women. The relationships of smoking during the first and second preg-nancies to outcomes in the second pregnancies were examined primarily through multivariate logistic regression. The adjusted relative risk (RR) of low birthweight (<2500 g) in the second pregnancy to not smoking in either pregnancy was 1.82 for those who smoked during the second pregnancy only, and 1.87 for those who smoked in both pregnancies. For those who smoked in the first pregnancy only, the RR was 0.97, not significantly different from 1. Adjusted smoking RRs for small-for-gestational age were larger, while adjusted RRs for fetal and neonatal mortality were smaller than the smoking RRs for low birthweight.     

Smoking during pregnancy: Missouri longitudinal study

Maternal smoking during pregnancy has been shown to be associated with reduced birthweight and increased fetal and infant mortality. This paper examines these patterns in first and second maternally-linked singleton pregnancies from 1978 to 1990 among 176 843 Missouri resident women with known smoking status in both pregnancies. Generally women were more likely to smoke in their second pregnancies (27.4%), than in their first (25.8%). This pattern was strongest among those whose first pregnancies occurred as teenagers, and for black women. The relationships of smoking during the first and second preg-nancies to outcomes in the second pregnancies were examined primarily through multivariate logistic regression. The adjusted relative risk (RR) of low birthweight (<2500 g) in the second pregnancy to not smoking in either pregnancy was 1.82 for those who smoked during the second pregnancy only, and 1.87 for those who smoked in both pregnancies. For those who smoked in the first pregnancy only, the RR was 0.97, not significantly different from 1. Adjusted smoking RRs for small-for-gestational age were larger, while adjusted RRs for fetal and neonatal mortality were smaller than the smoking RRs for low birthweight.     

Smoking and drinking habits before and during pregnancy in Spanish women.

STUDY OBJECTIVE--To investigate possible changes in smoking and drinking habits during pregnancy and to elucidate the sociodemographic factors associated with these changes in Spanish women. DESIGN--A cross-sectional survey. PARTICIPANTS AND SETTING--A total of 1004 pregnant women of between 12 and 18 weeks of gestation who were attending the antenatal clinic of the main regional hospital of Valencia (Spain) during 1989 were studied. All participants completed the study and only one eligible woman refused to participate when approached. MEASUREMENTS AND MAIN RESULTS--Information was obtained by structured questionnaire (Euromac questionnaire), which included items on age, educational level, marital status, occupation, parity, previous and present smoking habits, and previous and present alcohol consumption. Women were asked about the consumption of cigarettes and alcohol for a typical week before they knew they were pregnant, and details of current consumption were obtained for the week before the interview. The number of drinks taken per week was later converted to the amount of absolute alcohol (in g). Sixty per cent of the women smoked and 72% drank alcohol before pregnancy. Forty eight per cent of smokers stopped smoking and 37% of drinkers stopped drinking alcohol during pregnancy. No sociodemographic factor showed an independent association with either smoking or drinking cessation. Only the number of cigarettes and the amount of alcohol consumed before pregnancy were identified as significant independent predictors for stopping. CONCLUSIONS--Pregnant Spanish women seemed to stop smoking at about three times the rate found in Spanish women in the reproductive years. The sociodemographic variables usually associated with stopping smoking could not account for the high rate of quitting in these Spanish women, a rate higher than that in women from other developed countries. The high prevalence of smoking before pregnancy might explain not only the high rate of stopping smoking but also the absence of a well defined profile of "quitters". In our study, high levels of alcohol consumption were limited to a small group of pregnant women, and preventive efforts should be focused on this group.     

Smoking during pregnancy affects speech-processing ability in newborn infants

BACKGROUND: Tobacco smoking during pregnancy is known to adversely affect development of the central nervous system in babies of smoking mothers by restricting utero-placental blood flow and the amount of oxygen available to the fetus. Behavioral data associate maternal smoking with lower verbal scores and poorer performance on specific language/auditory tests. OBJECTIVES: In the current study we examined the effects of maternal smoking during pregnancy on newborns' speech processing ability as measured by event-related potentials (ERPs). METHOD: High-density ERPs were recorded within 48 hr of birth in healthy newborn infants of smoking (n = 8) and nonsmoking (n = 8) mothers. Participating infants were matched on sex, gestational age, birth weight, Apgar scores, mother's education, and family income. Smoking during pregnancy was determined by parental self-report and medical records. ERPs were recorded in response to six consonant-vowel syllables presented in random order with equal probability. RESULTS: Brainwaves of babies of nonsmoking mothers were characterized by typical hemisphere asymmetries, with larger amplitudes over the left hemisphere, especially over temporal regions. Further, infants of nonsmokers discriminated among a greater number of syllables whereas the newborns of smokers began the discrimination process at least 150 msec later and differentiated among fewer stimuli. CONCLUSIONS: Our findings indicate that prenatal exposure to tobacco smoke in otherwise healthy babies is linked with significant changes in brain physiology associated with basic perceptual skills that could place the infant at risk for later developmental problems.     

Caring-related inequalities in psychological distress in Britain during the 1990s

BACKGROUND: This paper examines recent trends in inequalities in psychological distress associated with the provision of unpaid care by those who look after frail older people and younger disabled adults and children. Caring activities intensified during the 1990s, associated with increasing amounts of time devoted to the more demanding types of care and to those relationships that typically make heavy demands on the carer. Heavy involvement in caregiving is often associated with symptoms of anxiety and distress, and the intensification of care may increase rates of distress in carers relative to that in non-carers. METHODS: A secondary analysis was carried out of data drawn from the first 10 waves of the British Household Panel Survey covering 1991-2000, based on around 9000 adults interviewed personally in successive waves. Symptoms of psychological distress, including anxiety and depression, were assessed using the 12-item General Health Questionnaire. RESULTS: Carers present higher rates of distress than noncarers and the health gap widens as the definition of caregiving focuses on those living with the person they care for, and those devoting 20 h or more per week to their caring activities. Differences in distress rates between carers and non-carers are greater for women than for men. There is no support for the hypothesis that inequalities in distress associated with caregiving have increased over time. CONCLUSION: There was no change during the 1990s in the extent of inequalities in psychological distress associated with caregiving in Britain. The need to maintain carers' emotional and mental health is as compelling as ever it was.     

Trends in informal care in Great Britain during the 1990s

The population of adult carers in Great Britain declined during the 1990s while the proportion of those heavily involved in providing informal care increased. The intensification of care-giving was associated with an increasing number of caring relationships that typically make heavy demands on the carer: spouse care and caring for a child or parent. The provision of informal care by friends and neighbours diminished resulting in an overall decline in care-giving between households. However, parents were increasingly looked after in their own homes by non-resident daughters. More women than men withdrew from the less intensive care-giving between households while more men than women took on the role of a spouse carer. By the end of the decade, as many men as women provided informal care for a spouse or partner. If the trends identified here continue beyond the study period, increasing resources will be required to identify heavily involved carers, assess their needs, and support them in their caring activities. The findings are based on secondary analysis of the British Household Panel Survey covering the years 1991-1998. As well as charting trends in the prevalence of informal care, changes in the locus of care, the number of care recipients, their relationship to their carer and the amount of time devoted to caring activities are described and interpreted.     

Smoking patterns and use of cessation interventions during pregnancy

BACKGROUND: Pregnant smokers should be counseled to quit smoking and offered effective cessation interventions. To improve understanding of how best to increase smoking-cessation rates during pregnancy, this study analyzed population-based surveillance data to describe women's smoking patterns and the use of cessation services during pregnancy. METHODS: Data were analyzed from the 2004 and 2005 New Jersey Pregnancy Risk Assessment Monitoring System, a population-based survey of postpartum women (n=4473). Measures of behaviors included the timing of quit relative to the learning of pregnancy, provider assistance, the use of cessation interventions, and barriers to quitting. Analyses were done in 2007 and 2008. RESULTS: An estimated 16.2% (95% CI=15.1, 17.3) of women smoked before pregnancy. Of these, 49.8% quit before entering prenatal care, and 5.2% quit after entering prenatal care. Almost all women reported that their prenatal care provider asked if they smoked, but only 56.7% reported that a provider counseled them to quit smoking. Only 11.5% of women who smoked in late pregnancy used a cessation method, including self-help materials (6.3%); medications (3.9%); face-to-face counseling (1.7%); telephone-based counseling (1.5%); Internet-based counseling (1.3%); and a class or program (1.0%). The most frequently reported barriers to quitting were cravings for a cigarette, stress, and being around people who smoked. CONCLUSIONS: Nearly half of pregnant New Jersey smokers quit before prenatal care, and very few quit later. Few continuing smokers used a smoking-cessation method when trying to quit or cut back. Efforts should be intensified to increase the knowledge, promotion, and referral to effective interventions to help pregnant smokers quit.     

Disparities in child health in the Arab region during the 1990s

Background  

While Arab countries showed an impressive decline in child mortality rates during the past few decades, gaps in mortality by gender and socioeconomic status persisted. However, large socioeconomic disparities in child health were evident in almost every country in the region.     

Smoking during pregnancy is harmful for mother and child

Smoking is an important adverse foetal exposure with a high prevalence in Western countries. Mothers who smoke during pregnancy have a strongly increased risk of delivering children born preterm or with a low birth weight. Recent studies suggest that foetal smoke exposure also leads to structural and functional developmental adaptations with permanent postnatal consequences. These adaptations may be beneficial in short term, but might lead to cardiovascular and metabolic disease in later life. Future research is needed to explore the underlying mechanisms. For now, clinicians should explain to pregnant women that smoking during pregnancy is not only harmful for their own health, but also affects their children's health many years later.     

Smoking during labour.

Smoking in hospitals is now forbidden. In several hospitals, however, women in labour are allowed to smoke in designated smoking areas. This study assesses whether smoking during labour increases the carboxyhaemoglobin concentrations in maternal and cord blood, taking into account the number of cigarettes smoked during pregnancy, duration of labour and parity. Women were questioned on their smoking behaviour shortly after delivery. A total of 295 mother-infant pairs were included in the study. Of the 94 (31.9%) smokers, 33 smoked during labour at home only and 34 during labour at the hospital. For newborns of smokers, the daily ration of cigarettes smoked by the mother during pregnancy and the number smoked during labour explained respectively 10.4% and 10.8% of the residual variance of carboxyhaemoglobin in cord blood. Smoking during labour significantly increases carboxyhaemoglobin levels. It should be prohibited in hospitals.     

Smoking during pregnancy and babbling abilities of the 8-month-old infant

Summary.   Animal experiments suggest that the fetal brain is sensitive to nicotine. Although much attention has been given to the relation between cigarette smoking during pregnancy and neurodevelopment in children, this remains controversial. Our study describes the relationship between maternal cigarette smoking during pregnancy and babbling abilities of the 8-month-old infant. In a longitudinal cohort, information was collected at the 16th week of gestation, at delivery and when the infant was about 8 months old. At this age babbling abilities of the infant were evaluated by a health visitor during a home visit. Singleton infants without any disability born at Aarhus University Hospital, Denmark, 1991–92 and still living in the Community of Aarhus at the age of 8 months were eligible ( n  = 2302). Complete follow-up was obtained for 1871 children (81.3%). A dose–response-like relationship between number of cigarettes smoked per day during pregnancy and babbling abilities was found after controlling for potential confounders. Smoking 10 or more cigarettes per day during pregnancy almost doubled the risk (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.1–3.6) of the infant being a non-babbler at the examination at 8 months. Among children who were breast fed for less than 4 months this risk was even higher (OR = 2.7, CI 1.3–5.8).     

Health and the environment in the 1990s.

Expectation of life at birth provides a simple measure of the state of health of a country. Differences in the expectation are examined in the United States over time and between males and females and Whites and non-Whites, and worldwide between market and nonmarket developed countries, and between developed and developing countries. The principal factors responsible for the trends and the current differences are changes in the social and physical environment, in personal behavior, and in medical care, and their relative importance is assessed. It is concluded that, at present, the principal environmental hazards worldwide are those associated with poverty of individuals within the market economies and of communities in the developing countries and that in the future, they will be the effects of overpopulation and the production of greenhouse gases.