Department of Sociology, Stockholm University, Stockholm, Sweden.
Department of Political and Social Sciences, European University Institute, San Domenico di Fiesole, Fiesole, Italy.
Addiction. 2018 Jun;113(6):1117-1126. doi: 10.1111/add.14158. Epub 2018 Feb 14.
AIMS: To investigate socio-economic disparities in smoking in pregnancy (SIP) by the mother's education, occupational class and current economic conditions. DESIGN: Cross-sectional analysis with linked survey and register data. SETTING: South-western Finland. PARTICIPANTS: A total of 2667 pregnant women [70% of the original sample (n = 3808)] from FinnBrain, a prospective pregnancy cohort study. MEASUREMENTS: The outcome was smoking during the first pregnancy trimester, measured from the Finnish Medical Birth Register. Education and occupational class were linked from population registers. Income support recipiency and subjective economic wellbeing were questionnaire-based measures of current economic conditions. These were adjusted for age, partnership status, residential area type, parental separation, parity, childhood socio-economic background, childhood adversities (the Trauma and Distressing Events During Childhood scale) and antenatal stress (Edinburgh Postnatal Depression Scale). Logistic regressions and attributable fractions (AF) were estimated. FINDINGS: Mother's education was the strongest socio-economic predictor of SIP. Compared with university education, adjusted odds ratios (aORs) of SIP were: 2.2 [95% confidence interval (CI) = 1.2-3.9; P = 0.011] for tertiary vocational education, 4.4 (95% CI = 2.1-9.0; P < 0.001) for combined general and vocational secondary education, 2.9 (95% CI = 1.4-6.1; P = 0.006) for general secondary education, 9.5 (95% CI 5.0-18.2; P < 0.001) for vocational secondary education and 14.4 (95% CI = 6.3-33.0; P < 0.001) for compulsory schooling. The total AF of education was 0.5. Adjusted for the other variables, occupational class and subjective economic wellbeing did not predict SIP. Income support recipiency was associated positively with SIP (aOR = 1.8; 95% CI = 1.1-3.1; P = 0.022). Antenatal stress predicted SIP (aOR = 2.0; 95% CI = 1.4-2.8; P < 0.001), but did not attenuate its socio-economic disparities. CONCLUSIONS: In Finland, socio-economic disparities in smoking in pregnancy are attributable primarily to differences in the mother's educational level (low versus high) and orientation (vocational versus general).
目的：通过母亲的教育程度、职业阶层和当前经济状况，研究妊娠期间吸烟（SIP）的社会经济差异。
设计：具有链接调查和登记数据的横断面分析。
地点：芬兰西南部。
参与者：来自 FinnBrain 的 2667 名孕妇（原始样本的 70%（n=3808）），这是一项前瞻性妊娠队列研究。
测量：通过芬兰医疗出生登记处测量妊娠头三个月的吸烟情况。教育程度和职业阶层从人口登记处链接。收入支持接受情况和主观经济幸福感是当前经济状况的基于问卷的衡量标准。这些因素根据年龄、伴侣关系状况、居住区域类型、父母离异、产次、儿童期社会经济背景、儿童期创伤和痛苦事件（创伤和痛苦事件量表）以及产前压力（爱丁堡产后抑郁量表）进行了调整。估计了逻辑回归和归因分数（AF）。
结果：母亲的教育程度是 SIP 最强的社会经济预测因素。与大学教育相比，SIP 的调整后比值比（aOR）分别为：职业技术教育 2.2（95%CI=1.2-3.9；P=0.011），普通和职业中等教育综合 4.4（95%CI=2.1-9.0；P<0.001），普通中等教育 2.9（95%CI=1.4-6.1；P=0.006），职业中等教育 9.5（95%CI 5.0-18.2；P<0.001），义务教育 14.4（95%CI=6.3-33.0；P<0.001）。教育的总 AF 为 0.5。在调整其他变量后，职业阶层和主观经济幸福感与 SIP 无关。收入支持接受情况与 SIP 呈正相关（aOR=1.8；95%CI=1.1-3.1；P=0.022）。产前压力预测 SIP（aOR=2.0；95%CI=1.4-2.8；P<0.001），但没有减轻其社会经济差异。
结论：在芬兰，妊娠期间吸烟的社会经济差异主要归因于母亲教育程度（低与高）和方向（职业与普通）的差异。
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