Avoiding Secondhand Smoke During Pregnancy

New Study of African-American Women Shows Social Factors Impact Success

San Diego, 27 January 2009 – Environmental Tobacco Smoke (ETS) commonly called secondhand smoke, can harm a developing fetus and may account for complications during pregnancy and birth. It is now known that non-whites experience more adverse pregnancy effects than do whites from smoking and ETS exposure. In an article published in the March 2009 issue of the American Journal of Preventive Medicine, researchers examined whether black, non-smoking women were able to avoid ETS exposure early in pregnancy and the social contextual factors that affected their success in avoiding secondhand smoke.

This study was conducted by investigators from The George Washington University Medical Center School of Public Health & Health Services, Children’s National Medical Center, RTI International, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Data were collected from 1044 women as part of a randomized, multiple–risk behavior intervention trial that addressed four risks for adverse pregnancy outcomes: cigarette smoking, ETS exposure, depression and intimate partner violence (IPV). In this study, the investigators analyzed data from 450 non-smokers who reported having partners, friends, household or family members who smoked. Demographic factors such as age, education, marital status and household income were collected, as was reproductive history information. Attitudes about being pregnant were assessed, as were mental health-related items such as depression symptoms and alcohol or illicit drug use. Interpersonal factors included having a current partner, the father’s desire to have the baby and the incidence of IPV either before or during pregnancy.

Direct ETS exposure factors such as smoking by others in the household, household smoking bans, perceived support from significant others to avoid secondhand smoke and perceived harmfulness of ETS exposure to the baby’s health were also measured. To accurately determine ETS exposure, cotinine levels in the mother’s saliva were measured. Cotinine is a widely accepted biomarker for tobacco exposure.

Twenty-seven percent of pregnant nonsmokers were confirmed as ETS avoiders. The odds of ETS avoidance were increased among women who reported household smoking bans, reported the father wanted the baby and where no/few family members/friends smoked. The odds were decreased among women who had a current partner, reported any intimate partner violence during pregnancy and reported little social support to prevent ETS exposure.

Writing in the article, Susan Michele Blake, PhD, The George Washington University Medical Center, School of Public Health and Health Services, states, “Results highlight the importance of comprehensive prenatal screening to identify a woman’s psychosocial and behavioral risks. Before addressing ETS exposure, it is important to gain a complete understanding of the social context of a woman’s pregnancy. While providing behavioral counseling and skills-based interventions, it is important to consider other factors that could exacerbate risks for IPV and poor pregnancy outcomes.”

The article is “Environmental Tobacco Smoke Avoidance Among Pregnant African-American Nonsmokers” by Susan M. Blake, PhD; Kennan D. Murray, MPH; M. Nabil El-Khorazaty, PhD; Marie G. Gantz, PhD; Michele Kiely, DrPH; Dana Best, MD, MPH; Jill G. Joseph, MD, PhD; and Ayman A.E. El- Mohandes, MD. It appears in the American Journal of Preventive Medicine, Volume 36, Issue 3 (March 2009) published by Elsevier.

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Full text of the article is available upon request; contact eAJPM@ucsd.edu to obtain copies. To schedule an interview, please contact the GWU Director of Media Relations, Anne Banner: 202 994 2261 or mcmacb@gwumc.edu.

Notes to Editors:
This study was part of the NIH – DC Initiative, a congressionally-mandated project to reduce infant morbidity/mortality in minority populations in the District of Columbia. Collaborating institutions included: Children’s National Medical Center, The George Washington University Medical Center, Georgetown University Medical Center, Howard University Hospital, RTI International, the National Institute of Child Health and Human Development and the National Center on Minority Health and Health Disparities.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of The American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

The American Journal of Preventive Medicine is ranked 13th out of 100 Public, Environmental & Occupational Health titles and 17th out of 100 General and Internal Medicine titles according to the 2007 Journal Citation Reports© published by Thomson Reuters.

About Elsevier

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