title: Secular trends in smoking during pregnancy according to income and ethnic group: four population-based perinatal surveys in a Brazilian city.
abstract: OBJECTIVE
  To assess socioeconomic and ethnic inequalities in smoking during pregnancy over three decades (1982-2011).
  
  
  METHODS
  Population-based study in Pelotas City, Brazil.
  
  
  METHODS
  All urban women giving birth in the city hospitals in 1982 (5909), 1993 (5223) and 2004 (4201), plus all urban and rural women delivering from January 2011 to April 2012 (6275).
  
  
  METHODS
  Self-reported smoking during pregnancy.
  
  
  RESULTS
  The prevalence of smoking during pregnancy fell from 35.7% in 1982 to 21.0% in 2011. In each survey, prevalence decreased with increasing income (p<0.001). In the poorest quintile, smoking fell by 27.4% in the period studied compared to 67.1% in the wealthiest quintile. In all surveys, prevalence was lower among white women than among those who classified themselves as black or brown (p<0.001). Over time, smoking declined by 50.0% among the former and 30.7% among the latter. Absolute and relative inequalities both increased over time.
  
  
  CONCLUSIONS
  The reduction in smoking during pregnancy was primarily due to a decline among white, high-income women. Further efforts are needed to reduce smoking among all population groups.
authors.affiliation: Faculty of Medicine, Maternal and Child Department and Post Graduation Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Mariangela F
authors.initials: MF
authors.lastname: Silveira
authors.affiliation: Department of Preventive Medicine, School of Medicine, University of São Paulo Pelotas, Pelotas, Brazil Faculty of Medicine, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Alicia
authors.initials: A
authors.lastname: Matijasevich
authors.affiliation: Faculty of Medicine, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Ana Maria B
authors.initials: AM
authors.lastname: Menezes
authors.affiliation: Faculty of Medicine, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Bernardo L
authors.initials: BL
authors.lastname: Horta
authors.affiliation: Faculty of Medicine, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Ina S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Faculty of Medicine, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Aluisio J D
authors.initials: AJ
authors.lastname: Barros
authors.affiliation: Post-Graduate Program in Health and Behavior, School of Medicine, Catholic University of Pelotas, Pelotas, Brazil.
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Barros
authors.affiliation: Faculty of Medicine, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
mesh_terms: D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D001938:Brazil / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000208:ethnology; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology* / Q000208:ethnology / Q000639:trends; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: inequalities; pregancy; smoking; trends
references.citation: JAMA. 2000 Jan 19;283(3):361-6
references.pmid: 10647799
references.citation: Lancet. 2000 Sep 23;356(9235):1093-8
references.pmid: 11009159
references.citation: Rev Saude Publica. 2004 Apr;38(2):261-7
references.pmid: 15122383
references.citation: Soc Sci Med. 1991;33(5):545-57
references.pmid: 1962226
references.citation: Soc Sci Med. 1996 Jul;43(2):243-54
references.pmid: 8844928
references.citation: Med Clin (Barc). 2005 Jan 29;124(3):86-92
references.pmid: 15710093
references.citation: Int J Epidemiol. 2006 Apr;35(2):237-42
references.pmid: 16373375
references.citation: Am J Public Health. 2006 Sep;96(9):1629-36
references.pmid: 16873756
references.citation: Acta Obstet Gynecol Scand. 2008;87(3):280-5
references.pmid: 18307066
references.citation: Am J Public Health. 2008 Apr;98(4):692-68
references.pmid: 17761568
references.citation: Int J Epidemiol. 2008 Aug;37(4):704-9
references.pmid: 17846051
references.citation: Tob Control. 2009 Apr;18(2):92-7
references.pmid: 18974226
references.citation: MMWR Surveill Summ. 2009 May 29;58(4):1-29
references.pmid: 19478726
references.citation: BMC Pregnancy Childbirth. 2010;10 Suppl 1:S3
references.pmid: 20233384
references.citation: Milbank Q. 2010 Mar;88(1):4-29
references.pmid: 20377756
references.citation: Matern Child Health J. 2010 Nov;14(6):901-9
references.pmid: 19795200
references.citation: J Gynecol Obstet Biol Reprod (Paris). 2011 Feb;40(1):42-9
references.pmid: 20864276
references.citation: Lancet. 2011 Jun 4;377(9781):1949-61
references.pmid: 21561658
references.citation: Int J Epidemiol. 2011 Dec;40(6):1461-8
references.pmid: 20702597
references.citation: Tob Control. 2012 Mar;21(2):96-101
references.pmid: 22345230
references.citation: Biomed Res Int. 2015;2015:345430
references.pmid: 26075231
references.citation: JAMA Pediatr. 2015 Jul;169(7):e151431
references.pmid: 26147058
references.citation: J Obstet Gynaecol Can. 2014 Oct;36(10):878-84
references.pmid: 25375300
references.citation: Cien Saude Colet. 2015 Mar;20(3):631-40
references.pmid: 25760105
references.citation: BMC Public Health. 2015;15:406
references.pmid: 25907460
references.citation: Sci Rep. 2015;5:9812
references.pmid: 25913126
references.citation: MMWR Morb Mortal Wkly Rep. 2012 Nov 2;61(43):877-82
references.pmid: 23114255
references.citation: Ned Tijdschr Geneeskd. 2012;156(46):A5092
references.pmid: 23151329
references.citation: PLoS Med. 2013;10(5):e1001390
references.pmid: 23667332
references.citation: Cad Saude Publica. 2013 Aug;29(8):1555-64
references.pmid: 24005921
references.citation: MMWR Surveill Summ. 2013 Nov 8;62(6):1-19
references.pmid: 24196750
references.citation: JAMA. 2014 Jan 8;311(2):183-92
references.pmid: 24399557
references.citation: Lancet. 2014 Sep 6;384(9946):857-68
references.pmid: 25209487
references.citation: Lancet Glob Health. 2014 Sep;2(9):e513-20
references.pmid: 25304418