title: Smoking during pregnancy among Turkish immigrants in Germany-are there associations with acculturation?
abstract: BACKGROUND
  We analyzed the association between different acculturation measures and smoking among pregnant immigrant women from Turkey and compared smoking rates between Turkish and German women.
  
  
  METHODS
  Perinatal data from a project on the influence of migration and acculturation on pregnancy and birth in Berlin was analyzed. An acculturation index (FRAKK) and two proxy measures (German language proficiency, length of stay in Germany) were used. We performed logistic regression models and calculated age-standardized prevalence ratios (SPR).
  
  
  RESULTS
  Smoking prevalence was 19.8% among pregnant Turkish women (n = 702) and 17.8% among German women (n = 2,999). The chance of being a smoker was significantly higher among Turkish women with a length of stay of ≥20 years compared to 0-4 years (OR = 3.63, 95% CI = 1.64-8.05); with good/very good language skills compared to none/minor skills; with high levels of acculturation compared to low levels (the latter only among 18-29-year-old women). Compared to German women, Turkish women with a short length of stay, low acculturation scores and none/minor language skills had lower smoking rates. This finding inverts with long length of stay, high acculturation scores and good/very good language skills (≥20 years: SPR = 2.14, 95% CI = 1.56-2.94).
  
  
  CONCLUSIONS
  Smoking among pregnant Turkish women increases with increasing acculturation. Additionally, immigrant women with a low acculturation level are less often smokers and women with a high level are more often smokers than German women. Prevention measures have to prevent women with a low acculturation from starting to smoke and to induce those with a high acculturation to quit. As smoking and acculturation are group phenomena, it is necessary to involve immigrant communities.
authors.affiliation: Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany; katharina.reiss@uni-bielefeld.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Reiss
authors.affiliation: Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany;
authors.forename: Jürgen
authors.initials: J
authors.lastname: Breckenkamp
authors.affiliation: Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany;
authors.forename: Theda
authors.initials: T
authors.lastname: Borde
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Brenne
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: David
authors.affiliation: Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany;
authors.forename: Oliver
authors.initials: O
authors.lastname: Razum
mesh_terms: D000069:Acculturation; D000293:Adolescent; D000328:Adult; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D037841:Pregnant People; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology* / Q000208:ethnology; D014421:Turkey / Q000208:ethnology; D044465:White People; D055815:Young Adult