Tobacco use and secondhand smoke exposure during pregnancy: an investigative survey of women in 9 developing nations

Objectives. We examined pregnant women''s use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa.Methods. Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005.Results. At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% Uruguay] to 35.0% Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home.Conclusions. Pregnant women''s tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.Tobacco use is widely recognized as one of the leading threats to global health.¹ Historically, the prevalence of smoking among women in the developing world has been very low, in part because of strong cultural constraints against women''s smoking; approximately 50% of men in developing nations smoke cigarettes, compared with 9% of women.² Averting an increase in the prevalence of smoking among women in developing nations is widely recognized as a significant public health opportunity.^3,4Pregnant women are a priority population for tobacco control efforts because both cigarette smoking and smokeless tobacco use during pregnancy pose serious risks to fetal health. Smoking during pregnancy may cause preterm delivery, low birthweight, and sudden infant death syndrome; smokeless tobacco use during pregnancy has been associated with stillbirth, preterm birth, and reduced birthweight.^5–8 Maternal tobacco use is also likely to expose infants and children to secondhand smoke (SHS) and to provide a role model for children''s use of tobacco. Intervening during pregnancy is also important because of the health risks to the woman, who potentially has many years of remaining life. For cigarette smoking, these health risks include lung and other cancers, coronary heart disease and stroke, and chronic obstructive pulmonary disease; health risks from smokeless tobacco products include oral and pancreatic cancer.^9,10The US National Institute of Child Health and Human Development''s Global Network for Women''s and Children''s Health Research consists of 10 research units chosen for scientific merit that are focused on improving maternal and children''s health in the developing world. To determine whether pregnant women''s tobacco use and SHS exposure are emerging public health issues, the Global Network undertook an investigative survey of pregnant women''s knowledge, attitudes, and behaviors regarding tobacco use and SHS exposure. Here we report findings on pregnant women''s experimentation with and use of tobacco products, their perceptions of the social acceptability of tobacco use by women, and their and their young children''s exposure to SHS.