Antenatal Tobacco Use and Secondhand Smoke Exposure in the Home in India.

Introduction: Antenatal tobacco use and secondhand smoke (SHS) exposure can have grave health consequences. We estimated the prevalence of tobacco use and SHS exposure in the home among pregnant and reproductive age women in India, and identified sociodemographic risk factors. Methods: Data were from the National Family Health Survey-3 (2005-2006), a population-based cross-sectional survey. We measured current tobacco use and SHS exposure in the home, and used logistic regression analysis to identify sociodemographic risk factors. Results: Nationally, antenatal tobacco use and SHS exposure in the home were reported by 9% and 25% of women, respectively. Tobacco use rates were slightly higher in reproductive age women (11%) than in pregnant women (9%). Common risk factors for tobacco use in pregnant and reproductive age women included older age, lower education, lower socioeconomic status, Scheduled Tribe status, Muslim religion, and rural residence. Being married lowered the risk of tobacco use among pregnant women, but increased the risk among reproductive age women. Antenatal SHS exposure decreased with older age and higher socioeconomic status. Conclusions: Antenatal tobacco use and SHS exposure in the home is a significant public health problem in India. Programs should target low socioeconomic status pregnant women, including single pregnant mothers. Implications: Antenatal tobacco use and SHS exposure in the home are significant public health problems in India. Intervention strategies should target younger women, single and socioeconomically disadvantaged pregnant women.

Antenatal tobacco use and iron deficiency anemia: integrating tobacco control into antenatal care in urban India.

BACKGROUND: In India, tobacco use during pregnancy is not routinely addressed during antenatal care. We measured the association between tobacco use and anemia in low-income pregnant women, and identified ways to integrate tobacco cessation into existing antenatal care at primary health centers. METHODS: We conducted an observational study using structured interviews with antenatal care clinic patients (n = 100) about tobacco use, anemia, and risk factors such as consumption of iron rich foods and food insecurity. We performed blood tests for serum cotinine, hemoglobin and ferritin. We conducted in-depth interviews with physicians (n = 5) and auxiliary nurse midwives (n = 5), and focus groups with community health workers (n = 65) to better understand tobacco and anemia control services offered during antenatal care. RESULTS: We found that 16% of patients used tobacco, 72% were anemic, 41% had iron deficiency anemia (IDA) and 29% were food insecure. Regression analysis showed that tobacco use (OR = 14.3; 95%CI = 2.6, 77.9) and consumption of green leafy vegetables (OR = 0.6; 95%CI = 0.4, 0.9) were independently associated with IDA, and tobacco use was not associated with consumption of iron-rich foods or household food insecurity. Clinics had a system for screening, treatment and follow-up care for anemic and iron-deficient antenatal patients, but not for tobacco use. Clinicians and community health workers were interested in integrating tobacco screening and cessation services with current maternal care services such as anemia control. Tobacco users wanted help to quit. CONCLUSION: It would be worthwhile to assess the feasibility of integrating antenatal tobacco screening and cessation services with antenatal care services for anemia control, such as screening and guidance during clinic visits and cessation support during home visits.