1. Society for Prevention Research 21st Annual Meeting (May 28-31, 2013) in San Francisco, CA A. Fogarasi-Grenczer 1, I. Rákóczi 2, K. L. Foley PhD. 3, P. Balázs MD. PhD 4 1. Semmelweis University, Faculty of Health Sciences, Institute of Health Promotion and Clinical Methodology, Department of Family Care Methodology, Hungary. 2. University of Debrecen, Health Care Faculty, Institute of Health Sciences, Deptartment of Family Care Methodology and Public Health, Hungary, 3. Medical Humanities Program, Davidson College, North Carolina, USA, 4. Semmelweis University, Faculty of General Medicine, Institute of Public Health, Hungary. THE IMPACT OF TOBACCO SMOKING ON PRETERM BIRTH AND LOW BIRTH WEIGHT: KEY ELEMENTS IN STRATEGY OF INTERVENTION ACKNOWLEDGEMENT: This publication was made possible by Grant Number 1 R01 TW007927-01 from the Fogarty Inter-national Center, the National Cancer Institute, and the National Institutes on Drug Abuse, within the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NIH. Total sample N= 11.358 The proportion of addicts (%) ≤ 10 cigarettes/ day (%) >10 cigarettes/ day (%) Body weight mean (±SD) PTB (%) LBW (%) Length of conception in weeks (mean) Stillbirth (%) Number of days in hospital after the birth Very high dependence n=0 0--- High dependence n=128 4.439.460.6 2762 (517) 16.326.227.54.413.9 Medium dependence n=887 30.653.446.6 2899 (518) 13.517.025.33.512.9 Low dependence n=1122 38.767.732.3 2930 (533) 14.217.422.72.810.9 Very low dependence n=764 26.379.820.2 3019 (498) 8.713.118.32.48.5 Non smoker n=8457 --- 3306 (521) 6.25.716.71.25.8 Fagerström Nicotine Dependence level N=2901 A KORASZÜLÉS KRÍZISSZITUÁC IÓ THEY ARE RESPONSIBLE FOR 80% OF INFANT MORBIDITY AND MORTALITY SOCIAL CRISIS (NICU AND AFTERCARE COST A LOT OF MONEY) FAMILY CRISIS (HUGE PHYSICAL, PSYCHOLOGICAL, FINANCIAL BURDEN) INDIVIDUAL CRISIS (COPING WITH DISORDERS AND DISABILITIES) VariablesOR95 % CI (lower-upper)P-value Roma vs. non- Roma 1.9911.3103.0280.001 Expected vs. unexpected pregnancy 1.3990.9971.9630.050 Employed vs. unemployed 1.1710.7961.7220.422 Education ≤ 8 grades vs. higher 2.3571.5743.5290.001 Housing without amenities vs. full amenities 3.1301.7095.7320.001 Urban vs. Rural 1.1560.8461.5800.363 Husband smoker vs. Non smoker 1.1730.8291.6580.367 Poverty vs. average income 1.0160.6751.5300.937 BMI categories under vs normal 1.0600.5552.0250.859 overweight 1.0860.6591.7890.746 obese 0.8640.4831.5460.622 Regular smoker husband vs. non smoker husband 1.2590.8701.8220.222 Table 2. The predictors of high and medium dependency (n=1015) as opposed to low and very low dependency (n=1886) Table 1. Correlation between the Fagerstrom dependency level and some obstetrical variables among pregnant women with known smoking status (N=11,358, the average number of cigarettes per day of smokers: 14.2) BACKGROUND In Hungary, premature birth is a serious public health concern (9% of all live births in 2011). The proportion is worse than the average in underprivileged counties, because of lower social status, smoking during pregnancy, and negative lifestyle factors. 26% of expectant mothers do not quit when they learn they are pregnant, but their level of dependency differs. Higher dependency levels increase the risk of negative maternal and fetal obstetrical outcomes. It is necessary to take in account the different levels of dependency while tailoring programs for successful interventions. METHODS We collected data of mothers with live births in 2009 and 2010 in Hungary’s four counties and the 10th district of the capital Budapest. Our target population was mothers delivered with live born babies in 2009 and 2010 (N=17,329). 75.35% of mothers (n=13,057) was interviewed by nurses of the local Maternity and Child Health Service (MCHS). The final number of sample with singleton births was 12,936. Demographic, social and economic data were collected with detailed questions about tobacco smoking. Medical and obstetrical data were obtained from hospital records and documentation of the local MCHS nurses. Dependency level was measured by the standard Fagerström Nicotine Dependency question- naire. In the analysis, we compared the obstetrical outcomes of smoking expectants to non-smokers. Using binary logistic regression analysis, we demonstrated the factors of strong (high and medium) dependency as opposed to the lower (low and very low) addiction level of regular smokers. All data were analyzed by the SPSS 20.0 statistical program at significance level p<0.05. RESULTS The proportion of expectant mothers who smoked on a regular basis is 25.5% (n= 2901). Their dependency level is different: 4.4% is high, 30.6% is medium, 38.7% is low, and 26.3% is very low. The proportion of non-smoking mothers together with those who gave up smoking during the first trimester of their pregnancy is 74.5% (n= 8457). There appears to be a dose-response relationship between nicotine depend- ency and poor obstetrical outcomes. Among mothers with high dependency level, the frequency of LBW, PTB, and stillbirths in the obstetrical history are very high: LBW 26.2%, PTB 6.3%, and stillbirths 4.4%. However, by decreasing dependency levels, these proportions are lower. Among non-smokers LBW is 5.7%, PTB is 6.2%, and stillbirth is 1.2%. The most significant correlates of high dependence are Roma eth- nicity, unexpected pregnancy, low level of education, and housing without amenities. CONCLUSIONS, INTERVENTIONS Higher dependence levels increase economic costs, as negative obstetrical out- comes increase the number of days spent in hospital. In case of higher dependency level, it is necessary to support the decision of giving up smoking, and the appli- cation of psychological and pharmaceutical devices might also be needed. In Roma groups, the training of future assistants has already been started. They will support the preventive work of involved medical services. Special postgraduate training of MCHS nurses and graduate courses of nursing students are essential to improve the effectiveness of tobacco cessation programs during the pregnancy. Preterm Birth, Low Birth Weight