Changes in smoking behaviour among young women over life stage transitions

Substance Use During Pregnancy: A Comparative Review of Major Guidelines

Importance

Substance use during pregnancy is a major health issue for both the mother and the fetus, but it also represents an important public health concern.

Objective

The aim of this review was to summarize and compare recommendations from recently published guidelines on substance use during pregnancy and especially regarding alcohol, smoking, and drug use.

Evidence Acquisition

A descriptive review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada, and the American College of Obstetricians and Gynecologists on substance use was conducted. Regarding the term "substance use," the most recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition substances were used.

Results

All the reviewed guidelines recommend appropriate counseling and screening women regarding alcohol, smoking, and drug use during the antenatal period, while the management options vary. More specifically, the prompt management of alcohol dependence is emphasized by all the guidelines except from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which makes no recommendation upon. The use of alcohol during breastfeeding should be avoided. Regarding smoking cessation, all guidelines recommend the use of certain psychosocial, behavioral interventions, and pharmacotherapy. All the guidelines, except the one from the WHO, suggest screening drug users for coexistent sexually transmitted infections. Brief interventions are considered beneficial, while a gradual decrease in benzodiazepines is suggested, as well as the discontinuation of marijuana and methamphetamine use. However, there is controversy regarding breastfeeding in those women as the WHO recommends in favor, whereas the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists recommend against this practice. Finally, all the guidelines state that, following delivery, close monitoring of the neonate is needed.

Conclusions

The diversity of guidelines' recommendations concerning substance use reflects the different ways of the management of pregnant women during routine antenatal care due to absence of strong evidence. More research in the areas of dispute may allow the adoption of an international consensus, in order to early detect and appropriately manage pregnant women with harmful addictions.

Explaining the social gradient in smoking and cessation: the peril and promise of social mobility

Smoking in high-income countries is now concentrated in poor communities whose relatively high smoking prevalence is explained by greater uptake but above all by lower quit rates. Whilst a number of barriers to smoking cessation have been identified, this is the first paper to situate cessation itself as a classed and cultural practice. Drawing on ethnographic research carried out in a working-class community in the North of England between 2012 and 2015, I theorise smoking cessation as a symbolic practice in relation to the affective experience of class and social mobility. I show that ambivalence about upward mobility as separation and loss translated into ambivalence about smoking cessation. The reason for this was that the social gradient in smoking operated dynamically at the level of the individual life course, i.e. smoking cessation followed upward mobility. A serious health problem was an appropriate reason to quit but older women continued to smoke despite serious health problems. This was linked to historical gender roles leading to women placing a low priority on their own health as well as the intergenerational reproduction of smoking through close affective links with smoking parents.

Changes in Smoking Behavior over Family Transitions: Evidence for Anticipation and Adaptation Effects

The study of changes in smoking behaviors over the life course is a promising line of research. This paper aims to analyze the temporal relation between family transitions (partnership formation, first childbirth, separation) and changes in smoking initiation and cessation. We propose a discrete-time logistic model to explore the timing of changes in terms of leads and lags effects up to three years around the event in order to measure both anticipation and adaptation mechanisms. Retrospective biographical data from the Santé et Itinéraires Professionnels (SIP) survey conducted in France in 2006 are used. Partnership formation was followed for both genders by a fall in smoking initiation and an immediate rise in smoking cessation. Childbirth was associated with increased smoking cessation immediately around childbirth, and additionally, females showed an anticipatory increase in smoking cessation up to two years before childbirth. Couple separation was accompanied by an anticipatory increase in smoking initiation for females up to two years prior to the separation, but this effect only occurred in males during separation. Our findings highlight opportunities for more targeted interventions over the life course to reduce smoking, and therefore have relevance for general practitioners and public policy elaboration.

Partnering and parenting transitions associate with changing smoking status: a cohort study in young Australians

OBJECTIVES

To examine the effects of partnering and parenting transitions on smoking continuity in young adults.

METHODS

A prospective cohort study was conducted involving 1084 young smokers and former smokers who completed questionnaires at baseline (2004-2006, aged 26-36 years) and 5 years later.

RESULTS

233/570 (40.9%) smokers quit and 58/514 (11.3%) former smokers resumed smoking during follow-up. For partnering transitions, compared with remaining not partnered, the likelihood of quitting was higher among men who became (RR 2.84 95% CI 1.62, 4.98) or stayed (RR 2.12, 95% CI 1.18, 3.80) partnered and women who became partnered (RR 1.50, 95% CI 1.03, 2.18). People who became (RR 0.14, 95% CI 0.03, 0.58) or stayed (RR 0.51, 95% CI 0.27, 0.95) partnered had a lower risk of resuming smoking than their continuously not partnered peers. For parenting transitions, having a first child born increased women's probability of quitting smoking relative to remaining childless (RR 1.74, 95% CI 1.30, 2.33), while having additional children did not.

CONCLUSIONS

The benefits of partnering were greater for men than women and transition into parenthood was of greater benefit to women.

Maternal trajectories of cigarette use as a function of maternal age and race

BACKGROUND

Patterns of smoking vary as a function of age and race. The goals of this study were to identify trajectories of maternal cigarette use over a 17-year span, and to determine if maternal age at first birth and race were associated with smoking trajectories.

METHODS

Pregnant women (N=690) were recruited at an urban prenatal clinic. The women (13-42years old; 62% African-American, 38% White) were interviewed about cigarette use during pregnancy and 6, 10, 14, and 16years postpartum. Growth mixture modeling (GMM) was used to identify trajectories. Regressions were used to determine if maternal age at first birth and race predicted trajectory class membership.

RESULTS

A GMM of maternal cigarette use delineated 5 groups: none/unlikely to use (33%), decreasing likelihood of use (6%), late desistance (5%), increasing likelihood of use (17%), and chronic use (39%). Women who became mothers at a younger age were more likely to be classified as late desisters or increasingly likely to smoke. White mothers were more likely to be chronic smokers. Different smoking trajectories and predictors of trajectories were identified for the African-American and White mothers. Covariates including prenatal substance use, hostility, education, and economic hardship also differentiated smoking trajectories.

CONCLUSIONS

Both prevention and treatment of smoking should be targeted to specific groups by age of first pregnancy and race. Pregnant smokers should be provided with more information and resources to help them avoid cigarettes during pregnancy and maintain abstinence after pregnancy.

Growth Trajectories of Health Behaviors from Adolescence through Young Adulthood

Based on nine waves of data collected during a period of 17 years (1990–2007), the present study explored different developmental trajectories of the following unhealthy behaviors: regular smoking, lack of regular exercise, lack of daily fruit intake, and drunkenness. A baseline sample of 1195 13-year-old pupils was from 22 randomly selected schools in the Hordaland County in western Norway. Latent class growth analysis revealed three developmental trajectories. The first trajectory was a conventional trajectory, comprising 36.3% of participants, who showed changes in smoking, physical exercise, fruit intake, and drunkenness consistent with the prevailing age specific norms of these behaviors in the Norwegian society at the time. The second trajectory was a passive trajectory, comprising 25.5% of participants, who reported low levels of both healthy and unhealthy behaviors during the 17-year period. The third trajectory was an unhealthy trajectory, comprising 38.2% of participants, who had high levels of unhealthy behaviors over time. Several covariates were examined, but only sex and mother’s and father’s educational levels were found to be significantly associated with the identified trajectories. While these findings need to be replicated in future studies, the identification of the different trajectories suggests the need to tailor intervention according to specific needs.

Do women grow out of risky drinking? A prospective study of three cohorts of Australian women

INTRODUCTION AND AIMS

To examine women's drinking behaviour relative to Australian guidelines and identify associated factors over the lifespan.

DESIGN AND METHODS

Data came from three prospective cohorts of the Australian Longitudinal Study on Women's Health aged 18-23 (n = 14,247), 45-50 (n = 13,715) and 70-75 years (n = 12,432) when first surveyed in 1996. The same women were re-surveyed at roughly 3-year intervals until 2012. At each survey, four drinking behaviours were based on two guidelines: long-term drinking (no more than two standard drinks per day) and episodic drinking (no more than four standard drinks on an occasion): (i) no risk (within both guidelines); (ii) low episodic risk (less than once a month); high episodic risk (at least once a month); long-term risk (more than two drinks per day regardless of episodic drinking).

RESULTS

No risk drinking increased with age, low episodic risk drinking remained almost constant between ages 18 and 39, and high episodic risk drinking declined rapidly. Few women drank at long-term risk. Factors associated with risky drinking varied with age; however, being a past or current smoker consistently increased the risk, and risks for smokers increased with age. Risky drinking was less likely to be practised by women providing care and needing help with daily tasks, or by pregnant women and those living with children.

DISCUSSION AND CONCLUSIONS

Risky drinking behaviour should be addressed in younger women and in those who smoke. Interventions to reduce risky drinking, possibly in combination with reducing smoking, could be offered through general practice centres.

Change in physical activity after smoking cessation: the Coronary Artery Risk Development in Young Adults (CARDIA) study

AIMS

To estimate physical activity trajectories for people who quit smoking, and compare them to what would have been expected had smoking continued.

DESIGN, SETTING AND PARTICIPANTS

A total of 5115 participants in the Coronary Artery Risk Development in Young Adults Study (CARDIA) study, a population-based study of African American and European American people recruited at age 18-30 years in 1985/6 and followed over 25 years.

MEASUREMENTS

Physical activity was self-reported during clinical examinations at baseline (1985/6) and at years 2, 5, 7, 10, 15, 20 and 25 (2010/11); smoking status was reported each year (at examinations or by telephone, and imputed where missing). We used mixed linear models to estimate trajectories of physical activity under varying smoking conditions, with adjustment for participant characteristics and secular trends.

FINDINGS

We found significant interactions by race/sex (P = 0.02 for the interaction with cumulative years of smoking), hence we investigated the subgroups separately. Increasing years of smoking were associated with a decline in physical activity in black and white women and black men [e.g. coefficient for 10 years of smoking: -0.14; 95% confidence interval (CI) = -0.20 to -0.07, P < 0.001 for white women]. An increase in physical activity was associated with years since smoking cessation in white men (coefficient 0.06; 95% CI = 0 to 0.13, P = 0.05). The physical activity trajectory for people who quit diverged progressively towards higher physical activity from the expected trajectory had smoking continued. For example, physical activity was 34% higher (95% CI = 18 to 52%; P < 0.001) for white women 10 years after stopping compared with continuing smoking for those 10 years (P = 0.21 for race/sex differences).

CONCLUSIONS

Smokers who quit have progressively higher levels of physical activity in the years after quitting compared with continuing smokers.

Comparing population attributable risks for heart disease across the adult lifespan in women

BACKGROUND

Recent estimates suggest that high body mass index (BMI), smoking, high blood pressure (BP) and physical inactivity are leading risk factors for the overall burden of disease in Australia. The aim was to examine the population attributable risk (PAR) of heart disease for each of these risk factors, across the adult lifespan in Australian women.

METHODS

PARs were estimated using relative risks (RRs) for each of the four risk factors, as used in the Global Burden of Disease Study, and prevalence estimates from the Australian Longitudinal Study on Women's Health, in 15 age groups from 22-27 (N=9608) to 85-90 (N=3901).

RESULTS

RRs and prevalence estimates varied across the lifespan. RRs ranged from 6.15 for smoking in the younger women to 1.20 for high BMI and high BP in the older women. Prevalence of risk exposure ranged from 2% for high BP in the younger women to 79% for high BMI in mid-age women. In young adult women up to age 30, the highest population risk was attributed to smoking. From age 31 to 90, PARs were highest for physical inactivity.

CONCLUSIONS

From about age 30, the population risk of heart disease attributable to inactivity outweighs that of other risk factors, including high BMI. Programmes for the promotion and maintenance of physical activity deserve to be a much higher public health priority for women than they are now, across the adult lifespan.

A prospective study of prevalence and predictors of concurrent alcohol and tobacco use during pregnancy

Concurrent drinking and smoking during pregnancy is a major public health concern. Changes in these behaviours are under-researched, although essential if effective interventions are to be implemented. Hence this paper investigated characteristics of women who decreased concurrent drinking and smoking during pregnancy. 1,591 women were identified as pregnant at one of three surveys from 2000 to 2006 of the Australian Longitudinal Study on Women's Health and not pregnant at the previous survey. Relative risks (RRs) were calculated for concurrent drinkers and smokers before pregnancy of (1) decreasing drinking, (2) decreasing smoking and (3) decreasing drinking and smoking during pregnancy. Three hundred and fifty-four women (22%) were concurrent drinkers and smokers before pregnancy; of these women, 73% decreased drinking, 72% decreased smoking and 53% decreased drinking and smoking during pregnancy. Decreased concurrent drinking and smoking was significantly higher among women who had at least 12 years education (RRs: 1.5-1.6), who drank at least 1-2 days/week (RRs: 1.5-1.6) and who had 3 or more drinks per occasion (RRs: 1.6-1.8), and significantly lower among heavy smokers, mothers of other children (RRs: 0.8) and disadvantaged women: those stressed about money, with poor mental health, low social support and experience of partner violence (RRs: 0.6-0.7). Clearly programs are needed to tackle concurrent drinking and smoking during pregnancy. Given many pregnancies are unplanned, these programs should target drinking and smoking before and during pregnancy, as well as disadvantaged women, to reduce the deleterious effects of concurrent substance use on their babies and themselves.

Correlates of smoking with socioeconomic status, leisure time physical activity and alcohol consumption among Polish adults from randomly selected regions

AIM

To determine the association between smoking status and leisure time physical activity (LTPA), alcohol consumption, and socioeconomic status (SES) among Polish adults.

MATERIAL AND METHODS

466 randomly selected men and women (aged 18-66 years) responded to an anonymous questionnaire regarding smoking, alcohol consumption, LTPA, and SES. Multiple logistic regression was used to examine the association of smoking status with six socioeconomic measures, level of LTPA, and frequency and type of alcohol consumed. Smokers were defined as individuals smoking occasionally or daily.

RESULTS

The odds of being smoker were 9 times (men) and 27 times (women) higher among respondents who drink alcohol several times/ week or everyday in comparison to non-drinkers (p < 0.0001 and p < 0.0001). Among men with the elementary/vocational level of education the frequency of smoking was four times higher compared to those with the high educational attainment (p = 0.007). Among women we observed that students were the most frequent smokers. Female students were almost three times more likely to smoke than non-professional women, and two times more likely than physical workers (p = 0.018).

CONCLUSION

The findings of this study indicated that among randomly selected Polish man and women aged 18-66 smoking and alcohol consumption tended to cluster. These results imply that intervention strategies need to target multiple risk factors simultaneously. The highest risk of smoking was observed among low educated men, female students, and both men and women drinking alcohol several times a week or every day. Information on subgroups with the high risk of smoking will help in planning future preventive strategies.

Assessing pregnant women's compliance with different alcohol guidelines: an 11-year prospective study

OBJECTIVE

To assess women's compliance with different Australian guidelines on alcohol intake during pregnancy and examine factors that might influence compliance.

DESIGN, SETTING AND PARTICIPANTS

We analysed prospective, population-based data on women aged 22-33 years who were pregnant before October 2001, when guidelines recommended zero alcohol (n = 419), or were first pregnant after October 2001, when guidelines recommended low alcohol intake (n = 829). Data were obtained from surveys conducted in 1996, 2000, 2003 and 2006 as part of the Australian Longitudinal Study on Women's Health.

MAIN OUTCOME MEASURES

Relative risks (RRs) for zero alcohol intake, low alcohol intake and compliance with alcohol guidelines, estimated by a modified Poisson regression model with robust error variance.

RESULTS

About 80% of women consumed alcohol during pregnancy under zero and low alcohol guidelines. Compliance with zero alcohol guidelines or low alcohol guidelines (up to two drinks per day and less than seven drinks per week) was the same for women who were pregnant before October 2001 and women who were first pregnant after October 2001 (20% v 17% for compliance with zero alcohol guidelines, P > 0.01; 75% v 80% for compliance with low alcohol guidelines, P > 0.01). Over 90% of women drank alcohol before pregnancy and prior alcohol intake had a strong effect on alcohol intake during pregnancy, even at low levels (RR for zero alcohol, 0.21 [95% CI, 0.16-0.28]; RR for low alcohol, 0.91 [95% CI, 0.86-0.96]). RR for compliance with guidelines was 3.54 (95% CI, 2.85-4.40) for women who were pregnant while low alcohol intake was recommended, compared with those who were pregnant while zero alcohol guidelines were in place.

CONCLUSION

The October 2001 change in alcohol guidelines does not appear to have changed behaviour. Risks associated with different levels of alcohol intake during pregnancy need to be clearly established and communicated.

[Maternal smoking during pregnancy and socioeconomic factors as predictors of low birth weight in term pregnancies in Nis]

BACKGROUND/AIM

Low birth weight (LBW) is a result of preterm birth or intrauterine growth retardation, and in both cases is the strongest single factor associated with perinatal and neonatal mortality. It is considered that socioeconomic factors, as well as mothers bad habits, play the most significant role in the development of LBW, which explains notable number of researches focused on this particular problem. The aim of this study was to characterize socioeconomic factors, as well as smoking habits of the mothers, and their connection with LBW.

METHODS

The questionnaire was carried out among mothers of 2 years old children (n = 956), born after 37 gestational weeks. The characteristics of mothers who had children with LBW, defined as < 2,500 g, (n = 50), were matched with the characteristices of mothers who had children > or = 2,500 g, (n = 906). For defining risk factors, and protective factors as well, we used univariant and multivariant logistic modeles.

RESULTS

As significant risk factors for LBW in an univariant model we had education level of the mothers, smoking during pregnancy, smoking before pregnancy, the number of daily cigarettes, the number of cigarettes used during pregnancy, paternal earnings and socioeconomic factors. In a multivariant model the most significant factors were socioeconomic factors, education level of the mothers, paternal earnings and mothers smoking during pregnancy.

CONCLUSION

Smoking during pregnancy and socioeconomic factors have great influence on LBW. Future studies should be carried out in different social groups, with the intention to define their influence on LBW and reproduction, as well. This should be the proper way of adequate health breeding planning for giving up smoking, the prevention of bad habits and melioration of mothers and children health, as the most vulnerable population.

Determinants of continuity and change over 10 years in young women's smoking

AIMS

To examine prospectively continuity and change in smoking behaviour and associated attributes over a 10-year period.

DESIGN, SETTING AND PARTICIPANTS

Participants (initially aged 18-23 years) in the Australian Longitudinal Study on Women's Health completed postal questionnaires in 1996, 2000, 2003 and 2006. The analysis sample was 6840 women who participated in all surveys and provided complete smoking data.

MEASUREMENTS

Outcome variables were transitions in smoking behaviour between surveys 1 and 2, 2 and 3, 3 and 4 and 1 and 4. Attributes that differentiated continuing smokers from quitters, relapsers from ex-smokers and adopters from never smokers were examined for each survey period. Explanatory variables included previous smoking history, demographic, psychosocial, life-style risk behaviour and life-stage transition factors.

FINDINGS

Over 10 years, 23% of participants either quit, re-started, adopted or experimented with smoking. Recent illicit drug use and risky or high-risk drinking predicted continued smoking, relapse and smoking adoption. Marriage or being in a committed relationship was associated significantly with quitting, remaining an ex-smoker and not adopting smoking. Living in a rural or remote area and lower educational attainment were associated with continued smoking; moderate and high physical activity levels were associated positively with remaining an ex-smoker.

CONCLUSIONS

Life-style and life-stage factors are significant determinants of young women's smoking behaviour. Future research needs to examine the inter-relationships between tobacco, alcohol and illicit drug use, and to identify the determinants of continued smoking among women living in rural and remote areas. Cessation strategies could examine the role of physical activity in relapse prevention.

Occasional tobacco use among young adult women: a longitudinal analysis of smoking transitions

OBJECTIVE

To describe prospective transitions in smoking among young adult women who were occasional smokers, and the factors associated with these transitions, by comparing sociodemographic, lifestyle and psychosocial characteristics of those who changed from occasional smoking to daily smoking, non-daily smoking or non-smoking.

DESIGN

Longitudinal study with mailed questionnaires.

PARTICIPANTS/SETTING

Women aged 18-23 years in 1996 were randomly selected from the Medicare Australia database, which provides the most complete list of people in Australia.

MAIN OUTCOME MEASURES

Self-reported smoking status at survey 1 (1996), survey 2 (2000) and survey 3 (2003), for 7510 participants who took part in all three surveys and who had complete data on smoking at survey 1.

RESULTS

At survey 1, 28% (n = 2120) of all respondents reported smoking. Among the smokers, 39% (n = 829) were occasional smokers. Of these occasional smokers, 18% changed to daily smoking at survey 2 and remained daily smokers at survey 3; 12% reported non-daily smoking at surveys 2 and 3; 36% stopped smoking and remained non-smokers; and 33% moved between daily, non-daily and non-smoking over surveys 2 and 3. Over the whole 7-year period, approximately half stopped smoking, one-quarter changed to daily smoking and the remainder reported non-daily smoking. Multivariate analysis identified that a history of daily smoking for > or = 6 months at baseline predicted reversion to daily smoking at follow-up. Being single and using illicit drugs were also associated with change to daily or non-daily smoking, whereas alcohol consumption was associated with non-daily smoking only. Compared with stopping smoking, the change to daily smoking was significantly associated with having intermediate educational qualifications. No significant associations with depression and perceived stress were observed in the multivariate analysis.

CONCLUSIONS

Interventions to reduce the prevalence of smoking among young women need to take account of occasional smokers, who made up 39% of all smokers in this study. Targeted interventions to prevent the escalation to daily smoking and to promote cessation should allow for the social context of smoking with alcohol and other drugs, and social and environmental influences in vocational education and occupational settings.

Does timing and sequencing of transitions to adulthood make a difference? Stress, smoking, and physical activity among young Australian women

The major changes of the transition to adulthood are argued to be stressful, and health-related behaviors such as smoking and physical activity may be adopted, consolidated, or abandoned at this time. On the other hand, research has suggested that the normative transitions of emerging adulthood, although involving considerable change, may be associated with low stress because they are perceived as both positive and normal at this life stage. This article examines relations between the timing and sequencing of life transitions and stress and health-related behaviors, focusing on the transition to young adulthood among Australian women. A total of 853 women aged 22 to 27 provided information about the timing and sequencing of 6 life transitions: moving out of home, stopping full-time education, starting full-time work, having the first live-in relationship, marriage, and motherhood-and stress, smoking, and physical activity. Most had moved out of home, stopped full-time education, and started full-time work, but only 14% had undertaken all 6 transitions. Overall, 70% of participants had made transitions "in order." Overall, the findings suggest that the relations between timing and sequencing of transitions, and indicators of health, are moderate for smoking, but small for stress and for physical activity. These effects remained after controlling for socioeconomic status of the participants' families of origin. Matching current social norms for the timing and sequencing of life changes may be of less importance for women's well-being than is commonly believed. Although the significant relations between early or "out of order" transitions and smoking are of concern, the smaller relations with stress and with sedentariness suggest that such transitions may have limited negative consequences, and support the view that individuals are active in choosing the life path that is appropriate for them and their circumstances.

Which women stop smoking during pregnancy and the effect on breastfeeding duration

BACKGROUND

Cigarette smoking during pregnancy increases the risk of adverse pregnancy outcomes and women who quit smoking at this time are able to reduce the risk of low birth weight, preterm labour, spontaneous abortion and perinatal death. This study investigates the socio-demographic characteristics of pregnant women who stop smoking during pregnancy and the association between stopping smoking and breastfeeding duration.

METHODS

A 12 month longitudinal study was conducted in two public maternity hospitals in Perth, Australia between mid-September 2002 and mid-July 2003. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks.

RESULTS

A total of 587 (55%) mothers participated in the study. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Women who were pregnant for the first time were twice as likely (OR = 2.05; 95% CI 1.047 - 4.03; p < 0.05) to quit smoking as multiparous women. Women who smoked more than 10 cigarettes per day were significantly less likely to quit smoking during pregnancy (OR = 0.36; 95% CI 0.18 - 0.69; p < 0.05). Women who consumed alcohol before pregnancy were three times more likely to quit smoking (OR = 2.58; 95% CI 1.00 - 6.66; p < 0.05). Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70; 95% CI 1.55 - 8.83; p < 0.05).

CONCLUSION

Pregnancy is a time when many women are motivated to quit smoking and providing targeted smoking cessation interventions at this time, which take into account factors predictive of quitting smoking, are more likely to be successful.