Abstract
Tobacco use is a leading cause of death and of poor pregnancy outcome in many countries. While tobacco use is decreasing in many high-income countries, it is increasing in many low- and middle-income countries (LMICs), where by the year 2030, 80% of deaths caused by tobacco use are expected to occur. In many LMICs, few women smoke tobacco, but strong evidence indicates this is changing; increased tobacco smoking by pregnant women will worsen pregnancy outcomes, especially in resource-poor settings, and threatens to undermine or reverse hard-won gains in maternal and child health. To date, little research has focused on preventing pregnant women's tobacco use and secondhand smoke (SHS) exposure in LMICs. Research on social and cultural influences on pregnant women's tobacco use will greatly facilitate the design and implementation of effective prevention programs and policies, including the adaptation of successful strategies used in high-income countries. This paper describes pregnant women's tobacco use and SHS exposure and the social and cultural influences on pregnant women's tobacco exposure; it also presents a research agenda put forward by an international workgroup convened to make recommendations in this area.
Acknowledgements
We thank the members of the expert working group who contributed to the discussion of the science and the development of research priorities on this topic: Dilyara Barzani, Ministry of Health, Kurdistan Regional Government, Iraq; Michael S. Kramer, McGill University Faculty of Medicine, Montreal, Canada; Ann M. Malarcher, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S.A.; Suneeta Mittal, All India Institute of Medical Sciences, New Delhi, India; and Sheela Shenoy Trivikram, Cosmopolitan Hospitals, Trivandrum, India.
Participants in the expert meeting entitled ‘Tobacco exposure during pregnancy in low- and middle-income countries: Establishing research priorities’ held September 8–10, 2008 were: Bernardo Agudelo-Jaramillo, Erik Augustson, Cathy Backinger, Dilyara Barzani, José Belizán, Vincenzo Berghella, John Bernert, Michele Bloch, Neal Brandes, F. Carol Bruce, Tsungai Chipato, Sven Cnattingius, Patricia Dietz, Mirjana Djordjevic, Thomas Eissenberg, Lucinda England, Ellen Feighery, Mario Festin, Christine Galavotti, Lorrie Gavin, Robert Goldenberg, Lorraine Greaves, Prakash Gupta, Paul Holmes, Carys Horgan, Yvonne Hunt, Ami Hurd, Ann Jensby, Annette Kaufman, Shin Kim, Priyadarshini Koduri, Michael Kramer, Mats Lambe, Harry Lando, Xingzhu Liu, Ann Malarcher, Elizabeth McClure, Mario Merialdi, Suneeta Mittal, Patricia Dolan Mullen, Katherine Murphy, Mimi Nichter, Thomas Novotny, Cheryl Oncken, Michael Paglia, Karen Parker, Alexandra Parks, Zhaoxia Ren, Jonathan Samet, Susan Sanders, Isabel Scarinci, David Stamilio, Mary Ellen Stanton, Alan Tita, Jorge Tolosa, Scott Tomar, Van Tong, Sheela Shenoy Trivikram, Deborah Winn, and Linda Wright.
Disclosure of interests: Bloch provided depositions on behalf of the U.S. government in the U.S. Department of Justice lawsuit, U.S.A. v. Philip Morris USA, Inc. et al., as part of her official duties. All other authors report no competing interests.