title: Association of maternal smoking status with breastfeeding practices: Missouri, 2005.
abstract: OBJECTIVE
  We sought to determine the association of smoking status as a risk factor for reduced initiation and duration of breastfeeding.
  
  
  METHODS
  The Missouri Pregnancy Related Assessment and Monitoring System collected a stratified sample of new mothers in 2005. Surveys were mailed, with telephone follow-up, and completed within 2 to 12 months after delivery. Respondents were classified as nonsmokers, smokers who quit during pregnancy, light smokers (<or=10 cigarettes per day), or moderate/heavy smokers (>10 cigarettes per day). Multivariable binomial regression and Cox proportional hazards models were used to assess breastfeeding initiation and duration according to smoking status.
  
  
  RESULTS
  Overall, 1789 women participated (weighted response rate: 61%). Approximately 74% of the women ever breastfed; 31% of the women ever smoked while pregnant. Compared with nonsmokers, the moderate/heavy smokers and light smokers were less likely to initiate breastfeeding, after controlling for sociodemographic characteristics, the presence of other smokers in the household, alcohol use, mode of delivery, and infant hospitalization. Compared with nonsmokers, the moderate/heavy smokers, light smokers, and smokers who quit during pregnancy were more likely to wean over time, controlling for the same covariates. There were no significant differences between nonsmokers and smokers regarding reasons for not initiating or ceasing breastfeeding.
  
  
  CONCLUSIONS
  Mothers who smoked initiated breastfeeding less often and weaned earlier than nonsmoking mothers. Incorporating knowledge of the association between smoking and breastfeeding into existing smoking-cessation and breastfeeding programs could provide opportunities to reduce perinatal exposure to tobacco smoke, improve interest in breastfeeding, and address other barriers to breastfeeding that smoking mothers may face.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. tweiser@npaihb.org
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Weiser
authors.forename: Mei
authors.initials: M
authors.lastname: Lin
authors.forename: Venkata
authors.initials: V
authors.lastname: Garikapaty
authors.forename: Robert W
authors.initials: RW
authors.lastname: Feyerharm
authors.forename: Diana M
authors.initials: DM
authors.lastname: Bensyl
authors.forename: Bao-Ping
authors.initials: BP
authors.lastname: Zhu
mesh_terms: D001942:Breast Feeding / Q000453:epidemiology*; D002675:Child, Preschool; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008923:Missouri; D011247:Pregnancy; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D014481:United States; D014886:Weaning