Academic journal article Canadian Journal of Public Health

Stopping Smoking during Pregnancy: Are We on the Right Track?

Academic journal article Canadian Journal of Public Health

Stopping Smoking during Pregnancy: Are We on the Right Track?

Article excerpt

ABSTRACT

Background: Recent data suggest that although smoking during pregnancy has declined in North America, this has more to do with falling rates of smoking initiation among women of childbearing age than with increased rates of pregnancy-related smoking cessation. One possible explanation is poor exposure to effective stop-smoking strategies. Better information about women who smoke during pregnancy may help target these interventions more effectively.

Methods: The study was a cross-sectional, self-administered survey of a consecutive sample of 916 (40.4% of eligible) women who delivered healthy babies in 1997-98 at a tertiary teaching hospital in Hamilton, Ontario. Our main focus was on health behaviours (smoking, drinking, eating, and exercise habits) before and during pregnancy; but we also included questions about the presence of (other) children and (other) smokers in the household, perceived health status, the subject's age and level of education, and whether or not the present pregnancy was planned. Factors associated with pregnancy-related smoking cessation were identified using multiple logistic regression.

Results: Respondents were better educated and healthier, but smoked at rates similar to women of childbearing age in Hamilton at the time of the survey. Two thirds of prior smokers or 20% of respondents overall continued to smoke during pregnancy. After adjustment for other factors, three factors were associated with ongoing smoking during pregnancy: having other smokers in the household; having other children in the household; and not having post-secondary education.

Conclusions: Many pregnant smokers are not being reached by current stop-smoking strategies. New ways to help these women and their partners are needed.

La traduction du resume se trouve a la fin de l'article.

Maternal smoking is one of the few known preventable risk factors for pre-term and low birthweight infants. Women who smoke during pregnancy are about twice as likely as non-smoking women to have a low birthweight baby, increasing the baby's risks for mortality, morbidity, and use of health services.1 Awareness of such risks gives some pregnant smokers the motivation to quit, but in most cases not; and those smokers who do quit usually relapse within the first year of delivery.2 Recent data from Canada3 and the U.S.4,5 suggest that although smoking during pregnancy has declined, this has more to do with falling rates of smoking initiation among women of childbearing age than with increased rates of pregnancy-related smoking cessation. One possible explanation is poor exposure to effective stop-smoking strategies.6 Better information about pregnant smokers may help target these interventions more effectively.

Previous studies have reported factors associated with pregnancy-related smoking cessation in Canadian women.7,8 However, one study surveyed women up to two years post-delivery and was limited to socio-demographic characteristics.7 The other did not control for confounding.8 Accordingly, we took advantage of data from an earlier study9 to further characterize women who, despite becoming pregnant, continue to smoke.

METHODS

As part of a separate study,9 we did a cross-sectional survey of consecutive post-partum women from November 1997 to March 1998 and June to November 1998 at St. Joseph's Healthcare, Hamilton; a 370-bed tertiary teaching hospital providing approximately 50% of the Regional Municipality's obstetrical care. All women who gave birth during the study and who could read English were eligible to participate, except mothers of infants requiring intensive care (who were excluded to avoid causing them additional anxiety). A 20-item self-administered questionnaire was distributed on admission to the post-partum unit and was collected prior to discharge.9 It had three main sections. Section one described the purpose of the study, in very general terms, and listed the conditions for participation. …

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