1. Birth statistics related to the socio- economic situation in Borsod-Abaúj- Zemplén County in Hungary in 2009 Andrea Grenczer, Péter Balázs MD, PhD., Ildikó Rákóczi Semmelweis University, Faculty of Health Sciences, Inst. of Public Health, Dept. of Family Care and Methodology Semmelweis University, Faculty of General Medicine, Institute of Public Health University of Debrecen, Health Care Faculty, Inst. of Health Sciences, Dept. of Family Care Methodology and Public Health NATIONAL AND INTERNATIONAL ASPECTS OF TOBACCO CONTROL Szeged, 2011. június 18.

2. Public Health Significance of our research Prevalence of tobacco smoking is rising among teenager girls and young females in Hungary Smoking females belong to the most endangered population during their pregnancy Proportion of smoking females is about 40%, expectant mothers are smoking nearly in 30% Decreasing trend of fertility is observed and tobacco smoking does influence fertility Smoking during pregnancy has a negative impact on the health status of mother and fetus alike

3. The present outcomes of our study: Results of our prior studies (Counties Vas and Szabolcs-Szatmár-Bereg 2008- 2009: research in families with preterm and IUGR babies, n=460) proved that there is a strong relationship with smoking during pregnancy and numerous further socioeconomic farctors. Smoking expectant mothers and families are living in the lower clasess and their majority have some kind of social disadvantages. In order to see more exactly the effects of social circumstances and the tobacco smoking, we extended the research to all live births cases registered in BAZ County in 2009.

4. Significant features of BAZ County (Hungarian Central Statisctical Office 2009) Socio-economic indices: - low level of employment - nationwide higher unimployment - great proportion of Roma population - nationwide higher proportion of people on social support system - highest proportion of criminal cases Health care indices: - great proportion of drug addicted persons - lowest life expectancy at birth - highest infant mortality (national average: 5,1‰, BAZ-County: 9 ‰ ) - great proportion of preterm birth (PTB) and low birth weigth (LBW) babies (national average: 8,7 % BAZ-County: 10,5 %) Low economic activity

5. The aim of this research: Identify factors of socioeconomic environment and life-style and determine the current health status of tobacco smoking expectant mothers in BAZ County. This way, we can pinpoint the most endangered populations, quantify the real extent of health consequences, further we can determine the number of experts and the means needed to prevent or decrease frequency of tobacco smoking. Topics of research: Identification of exposed populations (in socio-cultural-economic terms) Impact of smoking during pregnancy on specific lifestyle factors (nutrituion, drug addiction, physical activity) Impact of smoking during pregnancy on the expectant mother’s health status (entire obstetrical history with complaints, symptoms, conditions such as previous PTB and birth of IUGR babies) Impact of smoking during pregnancy on the newborns’ status (adaptivity, physical measures, chronic conditions) ETS exposition, stress situations Who is smoking during the pregnancy?

6. Methods: We concerned all live birth cases in 2009, inquiring the mothers using structured interviews in BAZ Couunty. Sample size N=4685, which is 67% of the total population (N=6927) concerned. Double source of information about expectant mothers: The 1st set of questions was answered by members of the Mother and Child Health Service besed on objective medical documents (events of family visits and consultations, obsterical ward documentation, laboratory and other parameters). The 2nd set of questions answered the mothers of newborn babies by methods of structured interviews (socioeconomic status, general and obstetrical history, health status, lifestyle factors, detailed questions about tobacco smoking and EPDS questions about depression. Statistical evaluation by SPSS version 15 IBR by Semmelweis University. The whole research was made possible by Grant Number 1 R01 TW007927-01 from the Fogarty International 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

7. Some outcomes presented: 1. figure: Smoking before pregnancy in the BAZ County sample in 2009.

8. 2. figure: Frequency of smoking during pregnancy (N=4612) in BAZ County in 2009. smoked Non smoked

9. 1. table: Significance of socio-economic factors (education, family status) of expectant mothers. VariablesNever smoked (n=2012) Regular Smokers (n=1074) Education: Less than 8 classes or basic school 46 %91 % Gymnasium28,5 %8,2 % Higher education (college or university) 25,5 %0,8 % Family status: married59,4 %26,6 % Registered partnership36,8 %66,1 % Divorced1,5 %2,6 % Single mother2,2 %4,7 %

10. 2. table: Specific socio-economic factors (employment, self-determined ethnicity, income per capita) VariablesNever smoked (n=2012) Regular Smokers (1074 fő) Employment: Employed before the pregnancy 49,5 %14,2 % Unimployed before the pregnancy 18 %33,7 % On maternity leave before pregnancy 23,9 %40,4 % Performing heavy physical activity 4,4 %11,3 % Self-determined ethnicity Non-Roma/Roma 75,3 % / 24,4 % Non-Roma/Roma 37,9 % / 61,5 % Per capita family income less than 30.000 HUF 35,8 %79,5 %

11. Dwelling: 51% of the sample in towns, 49% in villages and farm houses 3. table: Dwelling of Smokers and Non-Smokers VariablesNon-Smokers (n=2022 fő) Regular Smokers (n=1080 fő) Inner city area41 %23,8 % House owner61 %40,8 % Living with parents30,4 %40,2 % Sublet4,8 %13,2 % „ideal” dwelling (not owercrowded, dry with amenities) 64,3 %19,6 % 6 or more persons living together in a house/flat 24 %51,7 %

12. 4. table: ETS in both populations 5. table: Obstetrical hystory VariablesNever smoked (n=2022)Regular Smokers (n=1080) Husband/Partner is smoking29.1 %76.7 % Exposed in confined areasOften: 14.5 % Seldom: 23.3 % Often: 62.8 % Seldom: 22.9 % Never smoked (n=2022)Regular Smoker (n=1080) Unexpected pregnancy27.3 %62 % Period of becoming pregnant9.7 moths11.9 months Average of pregnancy weeks38.85 weeks38.24 weeks Babies’ Body Weight3321.57gr2928.2 gr ( - 393.37gr)

13. Conclusions Smoking during pregnancy is a problem rahter in the lower social classes thus related to the social structure of the society. The risk of becoming regular smoker is cleraly greater if the parents are of lower education, people are living in partnership or singles, in there is unimployment in he family or the per capita income is very low. Among Roma the frequency is twice greater than in the non-Roma population. Smoking expectant mothers and their family members light a cigarette often in confined spaces (within the house) presenting examples for the next generation thus making acceptable or even social norm the tobacco smoking. Expectant mothers are not only endangered by their own smoking, they are exposed very frequently also to ETS (Percentage of ETS exposition among non-smokers is only 37%, while 85% of regular smoker expectant mothers are exposed to addtional intoxication by ETS. Probably they are not avoiding smoking people, because they do not realize the danger being smokers themselves). Smoking mothers are less conscious in becoming pregnant proven by the high percentage of unexpected pregnancies. Tobacco smoking impacts fertility and the body weigt of the baby to be born.

14. Thank you for attention