Effects of parental smoking and level of education on initiation and duration of breastfeeding

Aim: To evaluate the effects of parental smoking and level of education on the initiation and duration of breastfeeding in a prospective cohort study on mother - infant pairs. Methods: We studied 543 mother - infant pairs enrolled after delivery at a hospital in Rome. Information about parents' characteristics were obtained from a questionnaire administered in hospital; the outcome of the study was the infant's feeding habits in the preceding 24 h, assessed by telephone every 2 wk. The effects of parental smoking and level of education on initiation and duration of breastfeeding were evaluated through multivariate logistic regression models and time-dependent Cox models. Results: After controlling for confounding factors, we found a negative effect for mothers' smoking both on breastfeeding initiation (odds ratio 2.19, 95% CI 1.05-4.55) and duration (hazard ratio 3.37, 95% CI 1.85-6.13) when at least one parent had a low level of education. Conclusion: Our study shows that maternal smoking, particularly when one of the parents has a low level of education, determines a negative effect on the initiation and duration of breastfeeding. Public health policy should promote educational programmes for both parents focused on quitting smoking, which could have positive effects on the initiation and duration of breastfeeding.