Gilbert Nicolas L, Bartholomew Sharon, Raynault Marie-France, Kramer Michael S
Maternal and Infant Health Section, Public Health Agency of Canada, Jeanne-Mance Building 1910C, 200 Eglantine, Ottawa, ON, K1A 0K9, Canada,
Matern Child Health J. 2014 Oct;18(8):1905-11. doi: 10.1007/s10995-014-1434-y.
A steady decrease in maternal smoking during pregnancy and a steady increase in breastfeeding rates have been observed in Canada in the past two decades. However, the extent to which all socioeconomic classes have benefited from this progress is unknown. Therefore, this study was undertaken to determine: (1) whether progress achieved benefited the entire population or was limited to specific strata; and (2) whether disparities among strata decreased, stayed the same, or increased over time. We used data from the National Longitudinal Survey of Children and Youth, which enrolled children aged 0-3 years between 1994 and 2008. Data collected at entry was analyzed in a cross-sectional manner. Between birth years 1992-1996 and 2005-2008, smoking during pregnancy decreased from 11.5 % (95 % CI 10.0-13.0 %) to 5.2 % (95 % CI 4.1-6.3 %) among mothers with a college or university degree and from 43.0 % (95 % CI 38.8-47.2 %) to 38.6 % (95 % CI 32.9-44.2 %) among those with less than secondary education. During the same period, the rate of breastfeeding initiation increased from 83.8 % (95 % CI 81.9-85.6 %) to 91.5 % (95 % CI 90.2-92.8 %) among mothers with a college or university degree and from 63.1 % (95 % CI 58.9-67.4 %) to 74.7 % (95 % CI 69.8-79.7 %) among those with less than secondary education. The risks of smoking and of not breastfeeding remained significantly higher in the least educated category than in the most educated throughout the study period, and these associations remained statistically significant after controlling for maternal age. Gaps between the least and the most educated mothers narrowed for breastfeeding but widened for smoking during pregnancy.
在过去二十年里，加拿大孕期女性吸烟率持续下降，母乳喂养率稳步上升。然而，所有社会经济阶层从这一进步中受益的程度尚不清楚。因此，开展了本研究以确定：（1）所取得的进展是惠及全体人口还是仅限于特定阶层；（2）不同阶层之间的差距随时间推移是缩小、保持不变还是扩大。我们使用了儿童与青年全国纵向调查的数据，该调查纳入了1994年至2008年间0至3岁的儿童。对入组时收集的数据进行了横断面分析。在1992 - 1996年出生组和2005 - 2008年出生组之间，拥有大专或本科学历的母亲孕期吸烟率从11.5%（95%置信区间10.0 - 13.0%）降至5.2%（95%置信区间4.1 - 6.3%），而初中以下学历的母亲孕期吸烟率从43.0%（95%置信区间38.8 - 47.2%）降至38.6%（95%置信区间32.9 - 44.2%）。在同一时期，拥有大专或本科学历的母亲开始母乳喂养的比例从83.8%（95%置信区间81.9 - 85.6%）升至91.5%（95%置信区间90.2 - 92.8%），初中以下学历的母亲开始母乳喂养的比例从63.1%（95%置信区间58.9 - 67.4%）升至74.7%（95%置信区间69.8 - 79.7%）。在整个研究期间，受教育程度最低的母亲吸烟和不进行母乳喂养的风险仍显著高于受教育程度最高的母亲，在控制了母亲年龄后，这些关联仍具有统计学意义。受教育程度最低和最高的母亲在母乳喂养方面的差距缩小了，但在孕期吸烟方面的差距扩大了。
