Early smoking initiation, sexual behavior and reproductive health — a large population-based study of Nordic women

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Abstract

Objective

To investigate associations between early smoking initiation, risk-taking behavior and reproductive health.

Method

A random sample of 69,486 women aged 18–45 from Denmark, Iceland, Norway and Sweden was surveyed in 2004–2005. We compared behavior and health among women who initiated smoking early (before age 15), later (at 15 or later) and never smokers.

Results

Adult women who initiated smoking early reported more lifetime and recent sexual partners and less condom use than women who initiated smoking later, and they had lower debut ages for coitus, pregnancy and alcohol consumption. Experiences of teenage pregnancy, abortion/miscarriage and having had at least one sexually transmitted infection (gonorrhea, herpes simplex, trichomonas vaginalis, chlamydia, genital warts) were more frequent among early than among later smoking initiators. Never smoking women reported fewer partners, later debut ages, and more condom use and were less likely to have experienced teenage pregnancy, abortion/miscarriage and having had at least one sexually transmitted infection than either group of smokers.

Conclusion

Early smoking initiators were more likely to engage in risk-taking behavior and experience adverse reproductive events than were smokers who initiated later. Age at smoking initiation may be an indicator of future reproductive health. Early smoking initiators represent targets for reproductive health information.

Introduction

The liability to initiate smoking is governed by genetic and environmental factors (Boomsma et al., 1994) and may be influenced by, e.g., peer smoking (Forrester et al., 2007), parental smoking (Bidstrup et al., 2009) and perceived level of maturation (Bratberg et al., 2007). The majority of smokers initiate the habit as teenagers (Forey et al., 2002). Social acceptance of pre-adolescent and young adolescent smoking is low, and the youngest smokers thus break a social norm. If this is reflective of an individual characteristic, individuals who initiate smoking at a relatively early age may differ from others also in behaviors that do not involve smoking. In addition, they may be influenced by the early exposure to tobacco itself or through early experiences potentially associated with smoking, such as exposure to alcohol.

Nonsexual risk-taking, such as smoking, may be associated with sexual risk-taking (Santelli et al., 2009). For instance, smokers have more sexual partners (Valois et al., 1999), more sex under the influence of alcohol or drugs and use condoms less consistently than do nonsmokers (Kalina et al., 2009). Problem behaviors that may emerge during adolescence, such as delinquency and substance use, tend to cluster in certain individuals (DuRant et al., 1999, Orr et al., 1991). Early age at smoking initiation may be associated with early sexual debut (Coker et al., 1994, Kuzman et al., 2007, Paul et al., 2000). Immature sexual decision making may lead to more risky sexual behavior (Edgardh, 2000, Mellanby et al., 1993), which in turn may increase the risk of unplanned pregnancy (Smith, 1997) and contraction of sexually transmitted infections (STIs) (Kaestle et al., 2005). Hence, early smoking initiators may be at an increased risk of experiencing unplanned pregnancies and STIs. However, few studies explicitly address the potential association between age at smoking initiation and reproductive health outcomes.

The aim of this study was to investigate associations between early smoking initiation, risk-taking behavior and reproductive health.

Section snippets

Subjects

A self-administered questionnaire on lifestyle and health was answered by 22,173 Danish, 15,025 Icelandic, 16,575 Norwegian and 15,713 Swedish women during 2004–2005. The overall participation rate was 66.9%. The women were aged 18–45 and were randomly drawn from the population registry in each country, in which each citizen has a unique personal identification number. The age distribution of the participating women was relatively even and similar to that among nonparticipating women (data not

Results

The majority of smoking women initiated smoking during their teenage years (median initiation age; Denmark, Iceland and Norway: 16.5, Sweden: 15.5). The proportion of early smoking initiators was relatively constant across age groups (16.2%, 13.8%, 12.4%, 11.6%, 12.3% and 14.4% of the sample in the age groups 18–20, 21–25, 26–30, 31–35, 36–40 and 41–45, respectively). Early smoking initiators currently smoked more heavily than did later smoking initiators (Table 1). Early smoking initiators

Discussion

This study shows that women who initiated smoking early engaged more in risky behaviors and had poorer reproductive health than did women who initiated smoking later and women who never smoked.

Early smoking initiation was associated with increased risk-taking as reflected in lower debut ages for coitus and alcohol consumption, timing of debut for condom use relative to coital debut and a greater number of lifetime coital partners. In addition, early smoking initiators currently smoked more,

Conclusion

In this large population-based sample of Nordic women, early smoking initiators were more likely to have engaged in risky behaviors and to have experienced STIs, pregnancy before age 18 and abortion/miscarriage than were later smoking initiators. Never smokers were less likely to have engaged in risky behaviors and to have experienced adverse reproductive events than were any of the two groups of smokers. In all models, the difference between never smokers and early smoking initiators was

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Acknowledgments

We thank Ann Nielsen and Kirsten E. Jensen for discussions. The study was funded by Merck & Co., Inc. (grant EPO 8014.016). The study was initiated and analyzed by the investigators.

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