Prevalence of smoking and associated factors among pregnant women in Japan

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Abstract

Objective.

This study was conducted to estimate the prevalence of smoking among pregnant women living in Japan and to analyze the factors associated with their smoking behavior.

Method.

Five hundred institutions with maternity services were randomly sampled from a list of the Japan Association of Obstetricians and Gynecologists. Of these institutions, 260 participated in the survey which was conducted in February 2002. Using a self-reported anonymous questionnaire, a survey on smoking behavior, drinking behavior and sleep status was conducted on pregnant women. Chi-square tests and logistic regression analyses were used to examine the factors associated with their smoking behavior.

Results.

Data were obtained from a total of 16,414 pregnant women. The prevalence of smoking during pregnancy was 9.9% [95% confidence interval (CI) 9.4%, 10.4%]. The quit rate of smoking among pregnant woman was 61.9% [95% CI 60.4%, 63.4%]. The odds ratios for smoking during pregnancy were significantly higher in women with relatively young age, less schooling, multiparous, exposure to passive smoking, short sleep duration and in women who drank.

Conclusion.

Smoking among pregnant women remains an important public health problem in Japan. It is necessary to promote antismoking measures based on the results of this study.

Introduction

The prevalence of smoking among Japanese men steadily decreased from 53.1% in 1990 to 43.3% in 2002 (The Ministry of Health, Labour and Welfare, Japan, 2002). In contrast, the prevalence of smoking among Japanese women was almost flat from 9.7% in 1990 to 10.2% in 2002 (The Ministry of Health, Labour and Welfare, Japan, 2002). The prevalence of smoking among women in their 20s and 30s increased from 11.9% in 1990 to 17.4% in 2002 and from 11.0% in 1990 to 17.2% in 2002 respectively (The Ministry of Health, Labour and Welfare, Japan, 2002). A study conducted by Japan Tobacco Inc. also reported that the prevalence of smoking among Japanese young women tended to increase (Japan Tobacco Inc., 2005). In their survey conducted in 2002, the prevalence of smoking among women in their 20s was reported at 24.3% and that among women in their 30s at 20.3% (Japan Tobacco Inc., 2005). In line with an increase in the smoking prevalence among women of reproductive age, it is of concern that the prevalence of smoking among pregnant women in Japan has increased. In fact, studies conducted around 1990 in Japan indicated that the prevalence of smoking among pregnant women was 3.8%–5.6% (Saito, 1991, Matsubara et al., 2000). However, a nationwide study conducted in 2000 reported a figure of 10.0%, which indicated that the prevalence of smoking among pregnant women had nearly doubled over the decade (The Ministry of Health, Labour and Welfare, Japan, 2001).

It is known that smoking during pregnancy seriously affects pregnancy and delivery, with increased risk of premature birth, abortion, perinatal death, placental abruption and placenta previa (Underwood et al., 1967, Meyer et al., 1976, Himmelberger et al., 1978, Naeye, 1980, Kleinman et al., 1988, Hofhuis et al., 2003). Furthermore, smoking during pregnancy affects fetuses and increases the risk of low birth weight (Underwood et al., 1967, Ojima et al., 2004) and sudden infant death syndrome (Schoendorf and Kiely, 1992, Anderson et al., 2005). Therefore, smoking during pregnancy is a serious problem for the health of both mother and child, and in Japan, where the prevalence of smoking among pregnant women has been particularly increasing, this issue must be urgently and thoroughly addressed. In order to effectively promote smoking cessation guidance and antismoking measures among pregnant women, it is important to clarify the factors associated with their smoking behavior. So far, studies in advanced countries have reported that various factors, such as age, years of schooling completed, race, the smoking status of family members, marital status, employment status and the number of pregnancies, were associated with smoking during pregnancy (Severson et al., 1995, McBride et al., 1998, Chatenoud et al., 1999, Ebrahim et al., 2000, Pirie et al., 2000, Kahn et al., 2002, Penn and Owen, 2002, Colman and Joyce, 2003). However, in Japan, there has not been any representative study on this issue, and the factors associated with smoking behavior among pregnant women have not been sufficiently clarified. Therefore, in the present study, a nationwide survey was conducted to determine the prevalence of smoking among pregnant women in Japan and to examine the factors associated with their smoking behavior.

Section snippets

Methods

This study was approved by the ethical committee in authors' facilities. A random sample of 500 clinical institutions with maternity patients was selected from a list of the Japan Association of Obstetricians and Gynecologists. A letter was sent to each of these 500 institutions inviting them to participate in our survey. A total of 390 institutions replied; of these, 110 institutions rejected the request and were excluded from the study. Study questionnaires were sent to the 280 institutions

Results

Among the 16,414 subjects analyzed, 4233 subjects had smoked before pregnancy, and the prevalence of smoking before pregnancy was 25.8% (95% CI: 25.1%, 26.5%). The number of subjects who smoked during pregnancy was 1627, and the prevalence of smoking during pregnancy was 9.9% (95% CI: 9.4%, 10.4%). The number of subjects who quit smoking after being motivated by pregnancy was 2619 out of 4233, and the quit rate of smoking was 61.9% (95% CI: 60.4%, 63.4%).

The prevalence of smoking was

Discussion

In this survey conducted in 2002, the prevalence of smoking among pregnant women in Japan was found to be 9.9%. In 2000, the Ministry of Health, Labour and Welfare, Japan conducted a nationwide survey on pregnancy, childbirth and infant growth among mothers with children aged between 14 days and 6 years (The Ministry of Health, Labour and Welfare, Japan, 2001). This survey revealed that the prevalence of smoking among mothers during pregnancy was 10.0%. Unlike the present study, in the survey

Conclusions

The present study showed that young age, limited schooling, multiparous, exposure to passive smoking, drinking and short sleep duration are associated with smoking in pregnant women. It is necessary to adopt measures aimed at smoking cessation in pregnant women in Japan in the future.

Acknowledgments

We would like to express our appreciation for their cooperation to the Japan Association of Obstetricians and Gynecologists, the people concerned in the maternity institutions, and the pregnant women who participated. We would also like to express our thanks to Masumi Minowa M.D. (Seitoku University) for his very helpful suggestions.

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    This study was supported by a Health Science Research Grant from the Ministry of Health, Labour and Welfare of the Japanese Government.

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