Is maternal cigarette or water pipe use associated with stopping breastfeeding? Evidence from the Jordan population and family health surveys 2012 and 2017–18

Background Maternal smoking is suspected to have negative impacts on breastfeeding, such as decreasing the quantity of breast milk, and reducing vitamin and fat concentrations in the milk in the late lactation period. Cigarette and water pipe tobacco products are widely used in Jordan. We aimed to estimate the association between use of different tobacco products and the rates of current breastfeeding. Methods Data from Jordan’s Population and Family Health Surveys 2012 and 2017–18 were examined. Last-born, living children, aged < 25 months, from singleton births, ever breastfed, and living with their mother were included. The key outcome variables were the current breastfeeding (during last 24 h) and tobacco usage status [water pipe tobacco (hookah or narghile) and/or cigarette tobacco]. Complex sample multivariate logistic regression analysis was used to evaluate the association of the current breastfeeding with maternal smoking status. Results Overall, 6726 infants were included in the study. The current breastfeeding rate in infants aged 0–6 months was 87%, compared with 43.9% in infants aged 12–17 months and 19.4% in infants aged 18–24 months. Overall, 4.4% had mothers who smoked cigarettes, 5.4% smoked water pipe, and 1.6% both cigarettes and water pipe. The proportion of breastfed infants in non-smoking mothers was 57.7% and, those in smoke water pipe, cigarette and both tobacco products were 55.4, 44.9, and 51.0% respectively. Univariate analysis revealed that women cigarette smokers had a lower odds ratio (OR) for current breastfeeding (OR 0.60, 95% Confidence Interval [CI] 0.39, 0.92). Multivariate analysis revealed that maternal cigarette smoking was associated with a lower odds ratio for current breastfeeding compared with mothers who smoked neither water pipe nor cigarettes (AOR 0.51, 95% Cl 0.30, 0.87). Conclusions These results indicate that maternal smoking is associated with termination of breastfeeding, suggesting that structured training should be organized for healthcare professionals, expectant mothers and the general public about the association between maternal smoking and cessation of lactation.

Tobacco, Cigarettes, and Women’s Status in Modern China

Cigarette smoking in the People’s Republic of China (PRC) is a highly gendered practice. The vast majority of China’s three hundred million plus smokers are men: in 2016, about 48 percent of men over age 15 were current smokers, but less than 2 percent of women smoked. The stark difference in this pattern of men and women’s smoking behavior is often attributed to lingering cultural taboos against female smoking assumed to have been in place for centuries. In fact, the virtual exclusivity of male smoking in China is of relatively recent vintage, dating only from the mid-1900s. From the 17th to the 19th centuries, smoking was socially acceptable for Chinese women. Granted, there were gendered and class differences in the location of tobacco consumption. Chinese men could smoke in public, but well-mannered women smoked privately out of view. After cigarettes were introduced into China at the end of the 19th century, some women, especially those living in coastal cities, took to smoking them rather than pipe tobacco. In the opening decades of the 20th century, the number of women who smoked cigarettes increased, but this trend was reversed in the 1930s and 1940s. After the establishment of the PRC in 1949, the number of women who smoked diminished even further such that by the 1980s, only a small percentage of women consumed tobacco products of any kind. Many social, economic, and cultural factors contributed to the gendered pattern of smoking that emerged in China over the course of the 20th century. An essential aspect of this history was the transformation in social norms that made cigarette smoking less rather than more respectable for women as time went on. At the beginning of the century, many women were already accustomed to smoking pipe tobacco. Some women, including those who identified as forward-looking “New Women,” preferred cigarettes. However, by mid-century cigarettes came to be widely associated with a stigmatized type of New Woman known as the “Modern Girl.” Portrayed in popular culture and political rhetoric alike as extravagant and sexually promiscuous, the Modern Girl’s pursuit of luxury came to symbolize bourgeois decadence and insufficient national loyalty. These associations came forward into the PRC period and as a result, most women born after 1949 elected not to smoke at all. Major differences in male and female smoking prevalence rates persist because female smoking remains objectionable to many Chinese citizens in the 21st century.

Water pipe tobacco smoking and risk of Coronary Artery Disease: A systematic review and meta-analyses

Background: Water pipe smoking has become a vitally important public health issue in the world with untruthful assumed less harmful effect. Objective: The aim of this study was to systematically review the association of water pipe tobacco smoking and risk of coronary artery disease (CAD). Methods: Up to September 25, 2018, we electronically searched the PubMed, Embase, and ISI Web of Science with no time restriction. We included observational studies and excluded conference abstracts, editorials, case-reports, case series, and reviews. With fixed model effect, we conducted Meta-analysis to evaluate the association between Water pipe smoking and coronary artery disease. Heterogeneity among studies was assessed by I2 square test. Publication bias was assessed by Egger test. P<0.05 set as significant level. Results: Among 248 paper records identified through database search, 52 full texts were eligible for full text assessment whereas 49 papers were excluded. Additionally, three studies were eligible for meta-analysis, which involved 58,960 adults with 1334 in the water pipe smoker group. Risk of CAD was increased in water pipe smokers compared to individuals who had never smoked water pipe but the result did not reach statistical significance (OR=1.18, 95% CI: 0.98- 1.38, p=0.06). We found that heavy water pipe smoking (40 to 50 sessions of water-pipe smoking/year) was associated with CAD compared to lower smokers defined as less than 40 to 50 water pipe/year (OR=2.001, 95% CI: 1.13-2.87). Conclusions: Heavy Water pipe smoking was associated to coronary artery disease on a clinical level. It seems very crucial to increase public awareness on adverse effects of water pipe smoking and its cessation in clinical setting.

Negative Marketing Effects on Utilization of Unsafe Products

Firms that intend to be ethically responsible for producing and promoting products that are counted as unsafe products. These products are not physically, socially, or ethically safe as they create significant risk or injury to the person who consumes or uses them. It not only harms the person but also the others in the surrounding and cause damage to society. These include cigarettes, cigars, and pipe tobacco made from dried tobacco leaves, which have a health impact on bystanders. Similarly, a firm's attempt to put efforts aimed at discouraging (not destroying) the demand for such products and indulges in negative marketing. Common negative marketing strategies include higher prices, scaled-down advertising, and product redesign. This paper is quantitative in nature and attempts to investigate the impact of negative marketing practices on unsafe products. The findings of the study will be useful for marketers to understand consumer behavior and attitude towards negative marketing strategies.