Continued smoking versus spontaneous quitting among pregnant women living in a high risk environment.

OBJECTIVES: In Hungary, 37% of women living in poverty were smokers in 2012. There are no valid data of pregnant women's spontaneous smoking cessation. METHODS: Our retrospective cohort study (2009-2012) targeted the most underdeveloped regions with an estimated 6-8.5% of Roma population. The sample (N = 12,552) represented 76% of the target population i.e. women in four counties in a year delivering live born babies. Chi-square probe and multivariable logistic regression model (p < 0.05) were used to assess relationship between socio-demographic characteristics and spontaneous cessation. RESULTS: Prior to pregnancy, the overall smoking rate was 36.8%. That of women in deep poverty and Roma was 49.7% and 51.1%, respectively. 70.3% of smokers continued smoking during the pregnancy. Among them 80.6% lived in deep poverty. Spontaneous quitting rate was 23.0%. Factors correlated with continued smoking included being Roma (OR = 1.95), undereducated (OR = 2.66), living in homes lacking amenities (OR = 1.48), and having regularly smoking partner (OR = 2.07). Cessation was promoted by younger age (≤ 18 years) (OR = 0.18), being married (OR = 0.50), and the first pregnancy. CONCLUSIONS: Tailored cessation programmes are needed for Roma, older, low-income, and multiparous women who are less likely to quit on their own. Engaging husbands/partners is essential to reduce smoking among pregnant women and second-hand smoke exposure.

[Birth weight of Roma neonates: effect of biomedical and socioeconomic factors in Hungary]. / Roma újszülöttek testtömegének vizsgálata: a biomedicinális és a szociális tényezok hatása.

INTRODUCTION: The last Hungarian study on birth weight of Roma neonates published in 1991 indicated -377 gram crude difference as compared to the general population. Exploration of this complex problem requires more sophisticated, multifactorial linear regression analysis. AIM: To compare Roma and non-Roma maternal and neonatal populations using biomedical and socioeconomic variables focusing on differences in the birth weight of the neonates. METHOD: Data collection with self-identified ethnicity was performed between 2009 and 2012 in five north and eastern counties of Hungary. The authors used the IBM-SPSS v.22 program for Chi-square and t-probe and linear regression analysis. RESULTS: In the sample of Roma (n = 3103) and non-Roma (n = 8918) populations there was a disadvantage in birth weight in Roma neonates by 294 gram in crude terms, but the linear regression model reduced it to 92 gram by the ethnic variable. CONCLUSIONS: Biological (genetic) impact on the weight difference cannot be excluded, however, the multifactorial statistical analysis indicates the priority of socioeconomic factors and behavioural patterns.

Birth-weight differences of Roma and non-Roma neonates--public health implications from a population-based study in Hungary.

OBJECTIVE: This study analyses the role of ethnicity-based birth weight differences at term (37-42 weeks) between neonates of Roma and non-Roma populations in Hungary, controlling for socio-demographic and biological characteristics of the mothers. METHODS: A cross-sectional survey among 9,040 mothers coupled with biometric data of the neonates was conducted in 2010. Inclusion criteria were: at term (37-42 weeks gestation) non-pathological pregnancies, and self-reported ethnicity. Birth weight was based on mothers' ethnicity, age, body mass index, education, marital and employment status, poverty level, household amenities, dietary and smoking habits using multiple linear regression. RESULTS: The mean difference between Roma and non-Roma neonates measured without controlling for possible confounding factors was -288.7 gram (p < 0.001, 95% CI = -313.4-263.9). In the linear regression model Roma neonates weighed on average 69.67 grams less than non-Roma neonates (p < 0.001, 95% CI = 30.51-108.83). The mother's underweight BMI, low education and smoking during pregnancy (p < 0.001), age under 18 years, no amenities of housing and insufficient consumption of fruits and dairy products also significantly influenced (p < 0.05) the neonates' birth weight. CONCLUSION: Roma ethnicity was independently correlated with lower birth-weight among at term neonates, controlling for known risk factors. Roma ethnicity may serve as a proxy for other unmeasured social or biological factors and should be considered an important covariate for measurement among neonates.

Risk factors of preterm birth and low birth weight babies among Roma and non-Roma mothers: a population-based study.

BACKGROUND: In 2009, 8.4% of live births in Hungary were low birth weight (LBW) and 8.7% were preterm (PTB). Roma are disproportionately represented in Northern Hungary where LBW and PTB are highest in the country (10.3% equally). This study evaluates the risk factors for LBW and/or PTB among the Roma and non-Roma populations in two Northern Hungarian counties. METHODS: We conducted a retrospective cohort study of 5469 non-Roma and 2287 Roma mothers who gave birth in 2009. Women were visited by the Maternal and Child Health Service nurses and completed in-person structured surveys on demographic, socio-economic, cultural and lifestyle factors. These data were combined with biometric data from hospital records. Bivariate statistics and a logistic regression analyses were used to determine risk factors for LBW and PTB. RESULTS: Roma had a higher incidence of PTB and LBW babies compared with non-Roma women (PTB 9.9% vs. 7.1%, LBW 12.2% vs. 6.5% P = 0.001). However, ethnicity was not related to PTB and LBW in multivariable analyses, when controlling for socio-demographic and lifestyle characteristics. Factors associated with LBW and PTB include being underweight, advanced maternal age, and smoking. CONCLUSION: Strategies that ensure healthy lifestyles must be well integrated in family-based interventions and in the schools, with special consideration for Roma women who have a higher prevalence of deleterious lifestyles and poor birth outcomes. Ensuring a healthy body weight and no smoking has important implications for the mother and foetus.

Factors associated with quit attempts and quitting among Eastern Hungarian women who smoked at the time of pregnancy.

INTRODUCTION: The purpose of this research was to assess factors associated with quit attempts and successful smoking cessation among a sample of socioeconomically disadvantaged pregnant women living in Eastern Hungary. MATERIALS AND METHODS: In-person interviews were conducted among 201 women residing in Eastern Hungary who self-identified as occasional or regular smokers at the time they learned they were pregnant. RESULTS: 54% of the women were smokers at the time they learned they were pregnant. Just over half tried to quit, but only 20% were successful. Factors associated with reduced likelihood of quit attempts included being a regular (vs. occasional) smoker (OR = 0.36, 95% CI 0.13-1.00) and being Roma (vs. non-Roma) (OR = 0.32, 95% CI 0.14-0.72). Women who completed high school were 7% times more likely to quit (OR = 7.5, 95% CI 1.68-33.2) and those who were employed were 7% times more likely to quit (OR = 7.6, 95% CI 1.88-30.35). Regular smokers were 88% less likely to quit than occasional smokers. DISCUSSION: Smoking cessation interventions targeting pregnant women are needed in Eastern Hungary. Efforts to integrate smoking cessation into the current excellent pre-natal care and health visitor program will reach most women who are pregnant or who have given birth within the preceding 3 years.