title: Smoking during pregnancy was up to 70% more common in the most deprived municipalities - a multilevel analysis of all singleton births during 2005-2010 in Finland.
abstract: OBJECTIVE
  We investigated whether there was an association between maternal smoking habits during pregnancy and municipality level deprivation defined based on education, income and unemployment after adjustment for individual level covariates, including socioeconomic status (SES), in Finland, a Nordic welfare state.
  
  
  METHODS
  Data were gathered from the Medical Birth Register and comprised all singleton births (n=337,876) during 2005-2010. To account for any correlation of women clustered within a municipality, we fitted generalized estimating equation (GEE) models.
  
  
  RESULTS
  In total, 15.3% of the women with singleton pregnancies smoked during pregnancy. After adjustment for individual level confounders, smoking during pregnancy was 5.4-fold higher among women with the lowest as compared with highest individual SES. Controlling for individual SES, age and year of birth, women living in municipalities defined as intermediately and highly deprived based on education were 53.7% (adjusted odds ratio [aOR] 1.537, 95% confidence interval [CI] 1.493-1.583) and 71.5% (aOR 1.715, 95% CI 1.647-1.785), respectively, more likely to smoke during pregnancy than women in the least deprived municipalities.
  
  
  CONCLUSIONS
  Individual SES is the strongest correlate of smoking during pregnancy but conditional on individual variables; lower municipality aggregate education is associated with up to 70% higher smoking prevalence.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA; Department of Obstetrics and Gynaecology, Kuopio University Hospital, P.O. Box 100, FI-70029 Kys Kuopio, Finland. Electronic address: shraisan@student.uef.fi.
authors.forename: Sari
authors.initials: S
authors.lastname: Räisänen
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. Electronic address: mkram02@emory.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kramer
authors.affiliation: National Institute for Health and Welfare (THL), P.O. Box 30, Paciuksenkatu 21, FI-00271 Helsinki, Finland; Nordic School of Public Health, Box 121 33, SE-402 42 Gothenburg, Sweden. Electronic address: mika.gissler@thl.fi.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Kuopio Welfare Research Centre (KWRC), Department of Social Sciences, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland. Electronic address: juho.saari@uef.fi.
authors.forename: Juho
authors.initials: J
authors.lastname: Saari
authors.affiliation: National Institute for Health and Welfare (THL), P.O. Box 30, Mannerheimintie 170, FI-00271 Helsinki, Finland. Electronic address: tuovi.hakulinen-viitanen@thl.fi.
authors.forename: Tuovi
authors.initials: T
authors.lastname: Hakulinen-Viitanen
authors.affiliation: Department of Obstetrics and Gynaecology, Kuopio University Hospital, P.O. Box 100, FI-70029 Kys Kuopio, Finland; School of Medicine, University of Eastern Finland,P.O. Box 1627, FI-70211 Kuopio, Finland. Electronic address: seppo.heinonen@hus.fi.
authors.forename: Seppo
authors.initials: S
authors.lastname: Heinonen
mesh_terms: D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D055361:Multilevel Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D012424:Rural Population / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology*; D012923:Social Class; D012959:Socioeconomic Factors
keywords: Childbirth; Multilevel analysis; Outcome; Pregnancy; Registries; Smoking; Socioeconomic status