Blake Susan M, Murray Kennan D, El-Khorazaty M Nabil, Gantz Marie G, Kiely Michele, Best Dana, Joseph Jill G, El-Mohandes Ayman A E
Department of Prevention and Community Health, School of Public Health and Health Services, The George Washington University Medical Center, Washington, DC 20037, USA.
Am J Prev Med. 2009 Mar;36(3):225-34. doi: 10.1016/j.amepre.2008.10.012.
Environmental tobacco smoke (ETS) exposure during pregnancy contributes to adverse infant health outcomes. Limited previous research has focused on identifying correlates of ETS avoidance. This study sought to identify proximal and more distal correlates of ETS avoidance early in pregnancy among African-American women.
From a sample of low-income, black women (n=1044) recruited in six urban, prenatal care clinics (July 2001-October 2003), cotinine-confirmed nonsmokers with partners, household/family members, or friends who smoked (n=450) were identified and divided into two groups: any past-7-day ETS exposure and cotinine-confirmed ETS avoidance. Bivariate and multivariate logistic regression analyses identified factors associated with ETS avoidance. Data were initially analyzed in 2004. Final models were reviewed and revised in 2007 and 2008.
Twenty-seven percent of pregnant nonsmokers were confirmed as ETS avoiders. In multivariate logistic regression analysis, the odds of ETS avoidance were increased among women who reported household smoking bans (OR=2.96; 95% CI=1.83, 4.77; p<0.0001), that the father wanted the baby (OR=2.70; CI=1.26, 5.76; p=0.01), and that no/few family members/friends smoked (OR=3.15; 95% CI=1.58, 6.29; p<0.001). The odds were decreased among women who had a current partner (OR=0.42; 95% CI=0.23, 0.76; p<0.01), reported any intimate partner violence during pregnancy (OR=0.43; 95% CI=0.19, 0.95; p<0.05), and reported little social support to prevent ETS exposure (OR=0.50; 95% CI=0.30, 0.85; p=0.01). Parity, emotional coping strategies, substance use during pregnancy, partner/household member smoking status, and self-confidence in avoiding ETS were significant in bivariate, but not multivariate analyses.
Social contextual factors were the strongest determinants of ETS avoidance during pregnancy. Results highlight the importance of prenatal screening to identify pregnant nonsmokers at risk, encouraging household smoking bans, gaining support from significant others, and fully understanding the interpersonal context of a woman's pregnancy before providing behavioral counseling and advice to prevent ETS exposure.
孕期接触环境烟草烟雾（ETS）会导致不良的婴儿健康结局。以往有限的研究主要集中在确定避免接触ETS的相关因素。本研究旨在确定非裔美国女性在孕期早期避免接触ETS的近端和更远端相关因素。
从在六个城市产前护理诊所招募的低收入黑人女性样本（n = 1044）（2001年7月 - 2003年10月）中，识别出可替宁确认的非吸烟者，其伴侣、家庭成员或朋友吸烟（n = 450），并将其分为两组：过去7天有任何ETS接触和可替宁确认的避免接触ETS。双变量和多变量逻辑回归分析确定与避免接触ETS相关的因素。数据最初于2004年进行分析。最终模型在2007年和2008年进行了审查和修订。
27%的孕期非吸烟者被确认为避免接触ETS者。在多变量逻辑回归分析中，报告有家庭吸烟禁令的女性避免接触ETS的几率增加（OR = 2.96；95%CI = 1.83，4.77；p < 0.0001），孩子父亲想要这个孩子的女性（OR = 2.70；CI = 1.26，5.76；p = 0.01），以及没有/只有少数家庭成员/朋友吸烟的女性（OR = 3.15；95%CI = 1.58，6.29；p < 0.001）。有现任伴侣的女性几率降低（OR = 0.42；95%CI = 0.23，0.76；p < 0.01），报告孕期有任何亲密伴侣暴力的女性（OR = 0.43；95%CI = 0.19，0.95；p < 0.05），以及报告很少有社会支持来预防ETS接触的女性（OR = 0.50；95%CI = 0.30，0.85；p = 0.01）。产次、情绪应对策略、孕期物质使用、伴侣/家庭成员吸烟状况以及避免接触ETS的自信心在双变量分析中显著，但在多变量分析中不显著。
社会背景因素是孕期避免接触ETS的最强决定因素。结果强调产前筛查以识别有风险的孕期非吸烟者、鼓励家庭吸烟禁令、获得重要他人的支持以及在提供行为咨询和建议以预防ETS接触之前充分了解女性孕期人际背景的重要性。
