Tobacco Smoke Use and Exposure Are Linked with Breastfeeding Psychosocial Factors and Behaviors

Background and Objective: To describe the intersection of tobacco smoke exposure with breastfeeding psychosocial predictors and practice. Methods: This is a secondary analysis of the Baby’s Breath study data among a free-living people from southeastern New England. Participants were 843 pregnant people who use (38%), recently quit (23%) or are exposed to (39%) tobacco smoke, who intended (77%) to breastfeed, and who were 55% married, 53% primiparous, 56% unemployed, 41% non-Hispanic White, 27% Hispanic, 13% non-Hispanic Black, and 28% <21, 39% 21-25 or 33%>25 years old. Main outcome measures were self-reported breastfeeding intentions and predictors at 16- and 32-weeks gestation, breastfeeding initiation and continuation at 3 and 6 months postpartum, and tobacco use and exposure at all timepoints. Chi-square and regression models assessed breastfeeding and smoking status and associations between psychosocial scores with breastfeeding intention and smoking status. Results: Breastfeeding variables differed by smoking exposure. Psychosocial scores were associated with breastfeeding intention. Knowledge, self-efficacy, and social support scores were associated with tobacco smoke exposure during pregnancy. Conclusions: Breastfeeding intention, practice, and associated knowledge, self-efficacy, and social support are associated with tobacco use and exposure. Tobacco smoke avoidance messaging and breastfeeding support addressing common antecedents will likely lead to less smoke-exposed, more successfully breastfed babies with better health outcomes.