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The More Education, the More Likely You'll Quit Smoking After Pregnancy

Poorly educated women are least likely to stay off smokes

TUESDAY, Oct. 29, 2002 (HealthDayNews) -- Poorly educated women are least likely to stay smoke-free after pregnancy, endangering not only their own health but that of their babies, a new study has found.

While 30 percent of women with a college degree who smoked before getting pregnant were no longer doing so three years after delivery, the rates of smoking among those who never finished high school didn't change in that period. These women also had the highest rates of smoking to begin with -- nearly 40 percent, compared with less than 12 percent among college grads, the study says.

When they did quit, less-educated women were much more likely to relapse in the first 1.5 years after giving birth, with only about 16 percent staying off tobacco. Nearly half of the college graduates who quit managed to remain off cigarettes during the first 17 months or so after delivery. Women who lived with a smoker were four times more likely to resume the habit.

The study also found that nearly 70 percent of college graduates who were smoking in the year before delivering said they quit for at least a week. That was nearly twice the rate among those who never finished high school -- 40 percent -- or who went no further than 12th grade -- 56 percent.

Poorer women were less likely to quit and more likely to relapse than were wealthier mothers, and education and income are closely linked. But even after accounting for income, the effects of education on tobacco use were strong, the researchers say.

"Less advantaged women fall further and further behind in terms of health," says Dr. Robert Kahn, a pediatrician at Cincinnati Children's Hospital and lead author of the study, which appears in the November issue of the American Journal of Public Health.

"These women face a cluster of hurdles in keeping up with more educated and more advantaged women," Kahn says. "Factors likely poverty, depression and the very powerful cues of other household smokers also contribute substantially in the persistence of their smoking."

While women who choose to resume smoking may be making the wrong choice, Kahn also blames the health-care system for failing poor mothers at a pivotal time.

"In the third trimester [of pregnancy] women are as healthy as they'll ever be in their reproductive years," he says. Their rates of smoking and drinking are low, they're typically eating well, and their odds of catching a sexually transmitted disease are small.

But after delivery, Kahn says, "there's such a focus on the infant that we let some critical health gains evaporate." Medicaid, the federal government's insurance plan for the poor, is often more generous to pregnant women than to those who've already given birth, he says.

Another "critical area" for future research, Kahn says, is to figure out how to encourage the family members of pregnant smokers to quit.

T. J. Mathews, a tobacco expert at the National Center for Health Statistics, commends Kahn and his colleagues for their research. However, he notes the data they used, which came from studies in 1988 and 1991, are dated and don't reflect current smoking rates.

In 2000, Mathews says, 12.2 percent of pregnant women in the United States smoked, according to information on birth certificates. That's probably an underestimate of the true percentage, and is somewhat less than the number of women who smoked in the months before learning they were pregnant, he says.

What To Do

For more on smoking during pregnancy, try the U.S. Centers for Disease Control and Prevention. And for more on women and smoking, visit the American Legacy Foundation.

SOURCES: Robert Kahn, M.D., M.P.H., assistant professor, pediatrics, Cincinnati Children's Hospital; T.J. Mathews, M.S., demographer, National Center for Health Statistics, Hyattsville, Md.; November 2002 American Journal of Public Health
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