Abstract
BackgroundThe widening socioeconomic gap in smoking during pregnancy remains a challenge to the Swedish antenatal care services. However, the influence of cultural factors in explaining the socioeconomic differences in smoking during pregnancy is not clear among the immigrant women. The aim of this study was to investigate whether the development of smoking prevalence among pregnant immigrant women in Sweden followed the trajectory which could be expected from the stages of the global smoking epidemic model in the women's countries of origin, or not.MethodsDelivery data on pregnancies in Sweden from 1982 to 2001 was collected from the Swedish Medical Birth Registry. From a total of 2,224,469 pregnant women during this period, all immigrant pregnant women (n = 234,731) were selected to this study. A logistic regression analysis and attributable fraction were used to investigate the association between smoking during pregnancy and the socioeconomic differences among immigrant women.ResultsOverall, the prevalence of smoking among pregnant immigrant women decreased from 30.3% in 1982 to 11.0% in 2001, albeit with remarkable differences between educational levels and country of origin. The greatest decline of absolute prevalence was recorded among low educated women (27,9%) and among other Nordic countries (17,9%). In relative terms, smoking inequalities increased between educational levels regardless of country of origin. The odds ratios for low educational level for women from other Nordic countries increased from 4.9 (95% CI 4.4-5.4) in 1982 to 13.4 (95% CI 11.2-16.2) in 2001, as compared to women with high education in the same group. Further, the total attributable fraction for educational difference increased from 55% in 1982 to 62% in 2001, demonstrating the strong effect of educational attainment.ConclusionsOur hypothesis that the socioeconomic time trend of smoking based on the stage of the world wide tobacco epidemic model related to country of origin of the immigrant women was not supported by our analyses. Our findings does not support a call for specific "culture sensitive" antismoking policies or interventions in Sweden or similar countries, but reinforce the existing evidence with a focus on women with a low educational level, regardless of cultural background.
Highlights
The widening socioeconomic gap in smoking during pregnancy remains a challenge to the Swedish antenatal care services
Study population Data on all pregnancies in Sweden resulting in a delivery from 1982 to 2001 was collected from the Swedish Medical Birth Registry (MBR), which preserves health profiles, marital status, age, nationality, and other demographic factors for all pregnant women in Sweden who participate in the national health system [22]
Women from other Nordic countries were a great majority (55.2%) in 1986; this group shrank to 14.7% in 2001
Summary
The widening socioeconomic gap in smoking during pregnancy remains a challenge to the Swedish antenatal care services. Women with low socioeconomic status include immigrants, lone mothers and young women, who remain as a major challenge to the tobacco interventions in the country It has been debated whether there is a specific need for culturally tailored programmes, in order to reach pregnant immigrants, who contribute to more than 20% of yearly deliveries in Sweden. Stress arising from displacement and introduction into new environment has been shown to expose immigrants to excess health risks and potential health hazards [4] Both low socioeconomic- and immigrant status are associated with the risks of less benefit to public health interventions, which in turn contribute to widening health gap, [5,6,7,8] and smoking has been identified as an important factor behind these inequalities [2,9]
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