The most incisive guide to issues facing the American family today . . . An invaluable resource for anyone wishing to stay on the cutting edge of research on family trends.

-W. Bradford Wilcox
Associate Professor of Sociology, University of Virginia 

Matrimony vs. the Marlboro Man

Bryce J. Christensen and Robert W. Patterson

Only a negligent physician would fail to warn a pregnant woman or new mother of the dangers of smoking. But only a married woman seems likely to listen to such warnings. Indeed, the effects of an intact marriage in fortifying pregnant women and new mothers against tobacco use stand out clearly in a study conducted at the National Institute of Health in Italy. Beginning their study of tobacco use among pregnant women and new mothers keenly aware that smoking harms such pregnant women, new mothers, and their offspring, the Italian researchers note:

Smoking is one of the most important avoidable causes of disability, mortality, and adverse maternal and fetal outcomes in Western countries. During recent decades, researchers have studied the adverse effects of smoking on conception, pregnancy, fetal, and child health. The associated adverse outcomes include low birth weight, reduced fetal growth, placenta previa, preterm birth, respiratory infections, asthma, sudden infant death syndrome, and hyperkinetic disorders.

Unfortunately, the researchers acknowledge, “tobacco use by pregnant women remains an important problem considering that the prevalence is far from the 2% goal in healthy people fixed in 2010 in the USA.”

To understand the reasons that tobacco use remains unacceptably high among pregnant women and new mothers, the scholars analyze data collected from 3,534 women receiving prenatal, delivery, and postpartum care from twenty-five Italian local health units (LHUs). Their analysis highlights a clear and strongly inverse relationship between breastfeeding and smoking among new mothers. “Women who are breastfeeding smoke less than not breastfeeding women,” the researchers conclude, “even after controlling for other predictors” (Odds Ratio, 0.43).

But breastfeeding is not the only practice that protects against maternal tobacco use; the wearing of a wedding ring is another. “Tobacco use before pregnancy,” the researchers report, “was more likely for unmarried [than for] married women” (Odds Ratio, 2.30). In other words, unmarried pregnant women are almost two-and-a-half times as likely as married peers to smoke. What is more, the researchers find that when married women do smoke at the beginning of pregnancy, they are more than twice as likely to quit the habit as are unmarried peers. “Quitting was less likely for unmarried women” than for married women, report the researchers, who calculate an Odds Ratio of 0.38.

America’s chief executive professes a strong desire to improve the health of the nation’s citizens. And then, when not smoking in a private room, he wages war on wedlock. Anyone who understands this study will recognize the baleful consequences of such incoherence—in Rome or in New York.

(Laura Lauria, Anna Lamberti, and Michele Grandolfo, “Smoking Behaviour Before, During, and After Pregnancy: The Effect of Breastfeeding,” The Scientific World Journal [March 2012]: 154910.)