title: Risk factors associated with nicotine dependence in a sample of Romanian pregnant smokers.
abstract: OBJECTIVE
  To fill the gap in assessing nicotine dependence during pregnancy in an unexplored population in Central and Eastern Europe and to analyze the associations of maternal characteristics and prenatal risk factors with moderate-heavy nicotine dependence among pregnant smokers.
  
  
  METHODS
  A questionnaire was applied to pregnant smokers in Romania to assess nicotine dependence and other related risks poorly documented in Central and Eastern Europe. The response rate was >80% and the valid sample included 137 pregnant smokers. Descriptive statistics and logistic regressions were used to assess nicotine dependence and to analyze the associations of maternal characteristic and prenatal risk factors with moderate-heavy nicotine dependence.
  
  
  RESULTS
  Approximately 43% of the pregnant smokers in our sample (59 of 137) had moderate to heavy nicotine dependence. Depressive symptoms were associated with moderate-heavy nicotine dependence among pregnant smokers (OR=3.07, p<0.05). Women carrying an unwanted pregnancy had higher odds of moderate-heavy nicotine dependence (OR=2.59, p<0.05) compared to other pregnant women. High stress, lack of social support, and socioeconomic status were not associated with nicotine dependence.
  
  
  CONCLUSIONS
  A large proportion of women had moderate-heavy nicotine dependence in a sample of Romanian pregnant smokers. The more dependent pregnant smokers were more likely to have depressive symptoms. Prenatal care should include brief nicotine dependence assessments and mental health screening and referrals for pregnant women who smoke. Special and intensive efforts, including psychosocial components, may be needed for the nicotine dependent pregnant smokers.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, and Institute for Health Care Studies, College of Human Medicine, Michigan State University, East Lansing, MI, USA. cristian.meghea@hc.msu.edu
authors.forename: Cristian I
authors.initials: CI
authors.lastname: Meghea
authors.forename: Ioana A
authors.initials: IA
authors.lastname: Rus
authors.forename: Diana
authors.initials: D
authors.lastname: Rus
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology; D005061:Europe, Eastern; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D012944:Social Support; D014029:Tobacco Use Disorder / Q000453:epidemiology*