title: Smoking prevalence, reduction, and cessation during pregnancy and associated factors: a cross-sectional study in public maternities, Rio de Janeiro, Brazil.
abstract: BACKGROUND
  Smoking epidemic in Brazilian women has later onset, smaller magnitude, and slower decreasing trend, compared to men. Among pregnant women, smoking has an additional deleterious effect. The purpose of this study was to analyze smoking prevalence during pregnancy and associated factors, and to describe the frequency of smoking reduction and cessation in public maternities of Rio de Janeiro State, southeastern Brazil, in 2011.
  
  
  METHODS
  A cross-sectional study was conducted in two maternities located at public hospitals in two cities of the Rio de Janeiro state, Niterói (maternity A) and of Rio de Janeiro (maternity B). Data were gathered by interviews 12 hours after the delivery, and analyses of prenatal cards and medical records. Smoking prevalence according to maternal characteristics, adequacy of prenatal care, and proportions of smoking reduction and cessation during pregnancy were calculated. Factors associated to smoking during pregnancy were estimated by logistic regression analysis.
  
  
  RESULTS
  Smoking prevalence at maternity A (24.8%, 95% CI: 21.1-29.0) and maternity B (17.9%, 95% CI: 15.8-20.1) were high. Prevalence rates were greater in women aged 20-34 years, mainly without partner, multiparous and brown or black skin color. Low education (OR = 2.14, 95% CI 1.21, 3.79) and multiparity (OR = 3.48, 95% CI 1.78, 6.81), at maternity A; adolescence (OR = 0.44, 95% CI 0.26, 0.75), black skin color (OR = 1.71, 95% CI 1.06, 2.74), low education (OR = 1.61, 95% CI 1.08, 2.40), and multiparity (OR = 1.58, 95% CI 1.03, 2.44), at maternity B, were associated with smoking in multivariable analysis. Adequacy of prenatal care and smoking prevalence showed an inverse association. More than half of the smokers kept the smoking habits during pregnancy. Reduction occurred mainly between the 1(st) and 2(nd) trimesters of pregnancy.
  
  
  CONCLUSIONS
  Smoking prevalence during pregnancy was higher for multiparous and less educated women. Population and individual strategies for smoking prevention and control must include actions specific for women, especially during the reproductive period.
authors.affiliation: Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Avenida Brigadeiro Trompowski, Rio de Janeiro (Hospital Universitário Clementino Fraga Filho, 5º andar), RJ, 21044-020, Brazil. pkale@iesc.ufrj.br.|Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro (IESC/UFRJ), Avenida Horácio Macedo S/N -- Cidade Universitária, Rio de Janeiro, RJ, 21941-598, Brazil. pkale@iesc.ufrj.br.
authors.forename: Pauline Lorena
authors.initials: PL
authors.lastname: Kale
authors.affiliation: Departamento de Epidemiologia e Bioestatística, Instituto de Saúde Coletiva, Universidade Federal Fluminense (ISC/UFF), Av. Marquês do Paraná, 303, 4º andar (Prédio anexo ao Hospital Universitário Antonio Pedro), Niterói, RJ, 24130-210, Brazil. sandracfonseca@yahoo.com.br.
authors.forename: Sandra Costa
authors.initials: SC
authors.lastname: Fonseca
authors.affiliation: Núcleo de Epidemiologia, Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF-FioCruz), Av. Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, 22250-020, Brazil. katiass@iff.fiocruz.br.
authors.forename: Kátia Silveira
authors.initials: KS
authors.lastname: da Silva
authors.affiliation: Secretaria Municipal de Saúde e Defesa Civil do Rio de Janeiro (SMSDCRJ), Rua Afonso Cavalcanti, 455/sala 809, Cidade Nova, Rio de Janeiro, RJ, CEP 20211-110, Brazil. penhammr@gmail.com.
authors.forename: Penha Maria Mendes
authors.initials: PM
authors.lastname: da Rocha
authors.affiliation: Secretaria Municipal de Saúde e Defesa Civil do Rio de Janeiro (SMSDCRJ), Rua Afonso Cavalcanti, 455/sala 809, Cidade Nova, Rio de Janeiro, RJ, CEP 20211-110, Brazil. rosanagarcia2709@gmail.com.
authors.forename: Rosana Garcia
authors.initials: RG
authors.lastname: Silva
authors.affiliation: Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro (IESC/UFRJ), Avenida Horácio Macedo S/N -- Cidade Universitária, Rio de Janeiro, RJ, 21941-598, Brazil. alinnechrispires@gmail.com.
authors.forename: Alinne Christina Alves
authors.initials: AC
authors.lastname: Pires
authors.affiliation: Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Avenida Brigadeiro Trompowski, Rio de Janeiro (Hospital Universitário Clementino Fraga Filho, 5º andar), RJ, 21044-020, Brazil. lourdes@iesc.ufrj.br.|Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro (IESC/UFRJ), Avenida Horácio Macedo S/N -- Cidade Universitária, Rio de Janeiro, RJ, 21941-598, Brazil. lourdes@iesc.ufrj.br.
authors.forename: Maria de Lourdes Tavares
authors.initials: Mde L
authors.lastname: Cavalcanti
authors.affiliation: Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Avenida Brigadeiro Trompowski, Rio de Janeiro (Hospital Universitário Clementino Fraga Filho, 5º andar), RJ, 21044-020, Brazil. ajcosta@iesc.ufrj.br.|Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro (IESC/UFRJ), Avenida Horácio Macedo S/N -- Cidade Universitária, Rio de Janeiro, RJ, 21941-598, Brazil. ajcosta@iesc.ufrj.br.
authors.forename: Antonio Jose Leal
authors.initials: AJ
authors.lastname: Costa
authors.affiliation: Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Avenida Brigadeiro Trompowski, Rio de Janeiro (Hospital Universitário Clementino Fraga Filho, 5º andar), RJ, 21044-020, Brazil. tguillen@iesc.ufrj.br.|Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro (IESC/UFRJ), Avenida Horácio Macedo S/N -- Cidade Universitária, Rio de Janeiro, RJ, 21941-598, Brazil. tguillen@iesc.ufrj.br.
authors.forename: Tania Zdenka Guillén
authors.initials: TZ
authors.lastname: de Torres
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult