Abstract
Objective. To study pregnant women's knowledge, attitudes and behaviors towards tobacco use and secondhand smoke (SHS) exposure, and exposure to advertising for and against tobacco products in Zambia and the Democratic Republic of the Congo (DRC). Design. Prospective cross-sectional survey between November 2004 and September 2005. Setting. Antenatal care clinics in Lusaka, Zambia, and Kinshasa, DRC. Population. Pregnant women in Zambia (909) and the DRC (847). Methods. Research staff administered a structured questionnaire to pregnant women attending antenatal care clinics. Main outcome measures. Pregnant women's use of tobacco, exposure to SHS, knowledge of the harms of tobacco and exposure to advertising for and against tobacco products. Results. Only about 10% of pregnant women reported ever having tried cigarettes (6.6% Zambia; 14.1% DRC). However, in the DRC, 41.8% of pregnant women had tried other forms of tobacco, primarily snuff. About 10% of pregnant women and young children were frequently or always exposed to SHS. Pregnant women's knowledge of the hazards of smoking and SHS exposure was extremely limited. About 13% of pregnant women had seen or heard advertising for tobacco products in the last 30 days. Conclusions. Tobacco use and SHS exposure pose serious threats to the health of women, infants and children. In many African countries, maternal and infant health outcomes are often poor and will likely worsen if maternal tobacco use increases. Our findings suggest that a ‘window of opportunity’ exists to prevent increased tobacco use and SHS exposure of pregnant women in Zambia and the DRC.
Acknowledgements
Funding for the study was provided by the U.S. National Institute of Child Health and Human Development (UO1 HD043475, UO1 HD043464 and UO1 HD040607), the U.S. National Cancer Institute, the U.S. Department of Health and Human Services' Office on Women's Health and the Bill and Melinda Gates Foundation. The manuscript was approved for publication by the National Cancer Institute and the National Institute of Child Health and Human Development. The authors appreciate the efforts of the field staff who administered the survey and the pregnant women who participated.
Disclosure of interest: Dr. Bloch provided depositions on behalf of the US government in the US Department of Justice lawsuit, USA v. Philip Morris USA, Inc. et al., as part of her official duties. All other authors report no competing interests.