1. Society for Prevention Research 21st Annual Meeting, The Science of Prevention: Building a Comprehensive National Strategy for Well-being, May 28 – May 31, 2013, San Francisco, CA
Tobacco Use During Pregnancy: Disentangling Ethnicity, Deep Poverty, and Other Socio-Cultural Factors Peter Balázs, Ph.D.*, Andrea Grenczer, Semmelweis University Budapest; Ildiko Rákóczi, Debrecen-Nyiregyhaza University Hungary; Kristie L. Foley, Ph.D., Davidson College NC USA
Introduction
In the deep poverty population the general prevalence of smok-ing prior to pregnancy mounted from 42.1% to 57.2% on aver-age (59.2% of Roma and 52.9% of non-Roma). Among them who smoked prior to pregnancy and continued use during pregnancy the proportion of Roma was 89.2% and that of non-Roma 67.6%.
1. Factors associated with discontinued smoking among women living in deep poverty (regardless of ethnicity) included age ≤17 years (Roma: OR=0.22, 95%CI= ; Non-Roma: OR= 0.25, 95%CI= ) and consuming fresh fruits at least every other day (Roma: OR=0.50, 95%CI= ; Non-Roma (OR=0.50, 95%CI=0.30 – 0.83).
2. Factors associated with continued smoking, regardless of eth-nicity, included routine exposure to secondhand smoke by the husband/partner (Roma: OR=1.83, 95%CI= ; Non-Roma: OR=2.44, 95%CI= ).
3. Unique to Roma women was the role that unexpected preg-nancy (OR=1.50, 95%CI= ) played on continued smok-ing during pregnancy.
4. Unique to non-Roma women, being married (OR=0.63, 95%CI= ) and consuming meat products at least every other day were protective (OR=0.6, 95%CI= ) while low education (OR=2.45, 95%CI= ) and living in over-crowded houses (OR=1.58, 95%CI= ) were associated with continued use.
In Hungary, the increase of tobacco smoking prevalence during the 2000s was due to increased smoking prevalence among young people, predominantly females. While in 1995 only 24% of women aged years were smoking, this proportion mounted to 42% in We found the same prevalence (42.1%) prior to pregnancy in our sample (N=11,725) of pregnant women delivered with live born babies in Hungary’s most underdeveloped north-eastern regions. We can confirm that low socio-economic status, especially deep poverty combined with specific cultural patterns of ethnic minorities are keeping the smoking prevalence at a consid-erably high level. In the whole sample, the overwhelming majority (85.1%) of Roma women are living in deep poverty contrasted to 25.8% of non-Roma. Thus they represented 58.4% smoking preva-lence contrasted to 37.4% of the non-Roma. Additionally, 9 out of 10 smoking Roma women continued the habit during the pregnancy. In our research, we aimed to estimate the socio-cultural factors con-tributing to smoking during pregnancy separately for Roma and non-Roma women in order to tailor cessation programs.
Table 1 Factors associated with discontinued smoking among Roma pregnant women living in deep poverty
Methods
We conducted our questionnaire based retrospective cohort study in Hungary’s 4 north-eastern counties with an average response rate of 78.93%. Data were collected by the local nurses of the Maternity and Child Health Service (MCHS). Among 11,725 pregnant women with known smoking status, 5,050 women (43.1%) were living in deep poverty, of which 2,560 self-identified as Roma and 1,857 as non-Roma ethnicity. Using 17 socioeconomic variables, logistic regres-sion was applied to assess factors associated with continued smoking stratified by Roma status (significance level, α ≤.05).
Conclusions
Table 2 Factors associated with discontinued smoking among Non-Roma pregnant women living in deep poverty
Deep poverty in synergism with sociocultural minority patterns have considerable impact on continued smoking or cessation during the pregnancy. According to the latest (2011) census data, the average proportion of Roma in our sampling area ranges between 6.0 and 8.5%. Additionally, among Roma the proportion of under age people is 32.0% a double that of the total population. It explains that reproductive health must be a primary concern in these ethnic minority communities.
While living in deep poverty, Roma and non-Roma communities share some common features related to continued smoking during pregnancy, however there are also unique socio-cultural factors to be considered. Thus, it is important even in commu-nities living in deep poverty to tailor cessation programs among Roma and non-Roma women to their unique needs.
Results
Among pregnant women the general smoking prevalence prior to pregnancy was 42.1% (58.4% of Roma and 34.7% of non-Roma). The average age of Roma was 24.3 years (SD=6.0) that of non-Roma 29.7 years (SD=5.4). In the sub-sample living in deep poverty, Roma represented 58.0% and non-Roma 42.0%. The average age of pregnant women decreased to 24.9 years (SD=6.4) among non-Roma and increased to 25.8% (SD=6.4) among Roma.
ACKNOWLEDGEMENT: This publication was made possible by Grant Number 1 R01 TW 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.

2. NIH = National Health Insurance mandatory for all
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