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

ObjectiveTo investigate associations between early smoking initiation, risk-taking behavior and reproductive health.MethodA 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.ResultsAdult 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.ConclusionEarly 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.