title: Patterns of cigarette and smokeless tobacco use before, during, and after pregnancy among Alaska native and white women in Alaska, 2000-2003.
abstract: OBJECTIVE
  To examine patterns of cigarette and smokeless tobacco use before, during, and after pregnancy among Alaska Native (AN) and white women living in Alaska.
  
  
  METHODS
  We used data from the 2000-2003 population-based Pregnancy Risk Assessment Monitoring System to describe patterns of self-reported prenatal tobacco use among AN and white women. We used multiple variable logistic regression analysis to identify maternal factors associated with quitting and relapse. The final sample included 5,458 women.
  
  
  RESULTS
  During 2000-2003, the prevalence of any tobacco use before pregnancy was twofold higher among AN women than among white women (60.0 vs. 27.5%), and the prevalence of any tobacco use during pregnancy and after pregnancy were each nearly threefold higher. Of the 25.8% (SE 0.9) of white women who smoked before pregnancy, 49.0% (SE 2.1) reported that they quit during pregnancy and of those, 41.1% (SE 2.9) relapsed postpartum. Of the 38.5% (SE 0.9) of AN women who smoked before pregnancy, 35.7% (SE 1.4) quit, and of those 57.0% (SE 2.4) relapsed. Of the 14.2% of AN women who chewed tobacco before pregnancy, 15.7% (SE 1.7) quit, and of those, 52.9% (SE 5.9) relapsed.
  
  
  CONCLUSIONS
  During 2000-2003, the prevalence of tobacco use was two to three times higher among AN women than among white women before, during, and after pregnancy. In addition, AN women had lower quit rates and higher relapse rates than white women. Comprehensive, culturally appropriate tobacco control approaches targeting AN women are needed to increase cessation during pregnancy and to decrease relapse.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS K-23, Atlanta, GA 30341, USA. skim1@cdc.gov
authors.forename: Shin Y
authors.initials: SY
authors.lastname: Kim
authors.forename: Lucinda
authors.initials: L
authors.lastname: England
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Dietz
authors.forename: Brian
authors.initials: B
authors.lastname: Morrow
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Perham-Hester
mesh_terms: D000328:Adult; D000413:Alaska / Q000453:epidemiology; D054521:Cultural Competency; D005260:Female; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D004930:Inuit / Q000208:ethnology* / Q000706:statistics & numerical data; D016015:Logistic Models; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology* / Q000517:prevention & control; D015995:Prevalence; D011644:Puerperal Disorders / Q000208:ethnology* / Q000517:prevention & control; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D014029:Tobacco Use Disorder / Q000208:ethnology* / Q000517:prevention & control; D014030:Tobacco, Smokeless; D044465:White People / Q000208:ethnology* / Q000706:statistics & numerical data