title: Maternal Smoking During Pregnancy Is Associated With Offspring's Musculoskeletal Pain in Adolescence: Structural Equation Modeling.
abstract: BACKGROUND
  Smoking and behavioral problems are related to musculoskeletal (MS) pain in adolescence. Maternal smoking during pregnancy (MSDP) is associated with offspring's behavioral problems but its relation to MS pain in adolescence is unknown. Our purpose was to investigate whether there is an association between MSDP, the number of pain sites in adolescence, and the factors that potentially mediate this relationship.
  
  
  METHODS
  We evaluated the association of MSDP with offspring's MS pain at 16 years among participants of the Northern Finland Birth Cohort 1986 (n = 6436, 3360 girls, 68% of all births) using Chi-square test and independent samples t test. We used structural equation modeling to assess the mediating factors stratified by gender.
  
  
  RESULTS
  MSDP was frequent (22%) associating with paternal smoking (p < .001), externalization problems at 8 years (p = .009 boys, p = .002 girls), offspring's smoking at 16 years (p < .001), externalizing problems at 16 years (p < .001), family's social class (p < .001) and intactness of the family status (p < .001). The mean number of offspring's MS pain sites was higher among adolescents whose mothers had smoked during pregnancy than among those whose mothers were nonsmokers (p = .002 boys, p = .012 girls). The association between MSDP and MS pain at 16 years was mediated by externalizing problems at 8 years (p < .001) and 16 years (p < 0.001).
  
  
  CONCLUSIONS
  MSDP increased the risk of offspring's MS pain in adolescence, and the association was mediated by offspring's externalizing problems during childhood and early adolescence.
  
  
  CONCLUSIONS
  This study indicates that MSDP increases the risk of MS pain in adolescence and the effect is mediated by externalizing problems. Our results add to the evidence on harmfulness of MSDP for offspring, and can be used as additional information in interventions aiming to influence MSDP.
authors.affiliation: Department of Physical and Rehabilitation Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Anni-Julia
authors.initials: AJ
authors.lastname: Määttä
authors.affiliation: Department of Physical and Rehabilitation Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.|Center for Life Course Health Research, University of Oulu, Oulu, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Paananen
authors.affiliation: Department of Physical and Rehabilitation Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.|Center for Life Course Health Research, University of Oulu, Oulu, Finland.
authors.forename: Riikka
authors.initials: R
authors.lastname: Marttila
authors.affiliation: Department of Physical and Rehabilitation Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.|Center for Life Course Health Research, University of Oulu, Oulu, Finland.|Unit of Primary Care, Oulu University Hospital, Oulu, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Auvinen
authors.affiliation: Department of Physical and Rehabilitation Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.|Center for Life Course Health Research, University of Oulu, Oulu, Finland.|Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu and Oulu University Hospital, Oulu, Finland.
authors.forename: Jouko
authors.initials: J
authors.lastname: Miettunen
authors.affiliation: Department of Physical and Rehabilitation Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.|Center for Life Course Health Research, University of Oulu, Oulu, Finland.|Finnish Institute of Occupational Heath, Oulu, Finland.
authors.forename: Jaro
authors.initials: J
authors.lastname: Karppinen
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D059352:Musculoskeletal Pain / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D011795:Surveys and Questionnaires