Breastfeeding and Smoking 2AbstractSigmund Freud is widely known for his psychosexual stages of development. He believed that ifthese stages were not completed, a fixation would develop. According to Freud, oral fixations,such as thumb sucking, gum chewing, and smoking, were the result of an uncompleted oralstage. We believed that earliest form of oral pleasure, breastfeeding, would have a connectionwith an oral fixation that can occur later in life (smoking). We hypothesized that the duration ofbreastfeeding, whether too long or too short would have some kind of effect with the incidenceof smoking later in life. Eighty-seven undergraduate participants were sampled from LoyolaUniversity in New Orleans. The participants were between the ages of 18 and 22 years and weremale (n=41) and female (n-46). The participants were given a questionnaire to fill out thatcontained questions concerning the incidence and duration of breastfeeding and smokingbehaviors. Our independent variable was the duration of breastfeeding and our dependentvariable was smoking or smoking behaviors. The results of our research proved to beinconclusive. We could not find a relationship between these two variables, but we hope that ourresearch could be used as a foundation for other researchers who are interested in this or relatedtopics.

Breastfeeding and Smoking 3The Correlation Between the Duration of Breastfeeding and Smoking in Later LifeThe topic of breastfeeding is and always has been very debatable. Biologicallyspeaking, extended research has shown the many benefits of breastfeeding. A cohortlongitudinal study was done on the effects of breastfeeding on a child`s development at five yearsafter their participation in this study began (at birth). A positive relationship was found betweenthe PPV-T scores and the duration of breastfeeding with an increased number on the tests as theduration of breastfeeding was increased (Quinn, 2001). This is just one of the many studies thatshow the positive effects of breastfeeding and adequate duration. One of the reasons why manyAmerican mothers have a significantly lower breast-feeding duration is because of social viewsand societal norms. Today in the U.S. many people would be startled to see a four-year-oldnursing at his/her mother`s breast. This is one reason why American mothers wean their childrenearlier than mothers of other cultures. There are other reasons why American mothers wean theirinfants earlier. According to a study on the factors associated with weaning in the first threemonths, conducted by researchers in Michigan and Nebraska, younger and less educated womentend to breastfeed their infants for a shorter amount of time than other women. This is due to thelack of support and education in breastfeeding. Three factors in the cessation of breastfeedingare also discussed in this study, a return to work, insufficient supply of milk, and age and SES.Specifically focusing on the latter, women of a lower SES tend to breastfeed their infants for ashorter amount of time, in terms of months (Schwartz, 2002). Not only are the cognitive benefitsof breastfeeding high, but so are the economical benefits. In a study funded by the NationalInstitute of Nursing Research, the researchers recognize this fact. One key point the researchersbring up is that " increased duration of breastfeeding offers health benefits to mothers and infants

Breastfeeding and Smoking 4... which is specific to low-income women. They may find that breastfeeding is empoweringand helps with pregnancy spacing.. .may also save the mother and society resources" such asfood and money (Pugh, 2002). According to the AAP (American Association of Pediatrics),sixty-four percent of mothers initiate nursing at birth, twenty-nine percent nurse until six monthsof age, and 16 percent nurse until one year of age. Global views of breast-feeding varysignificantly. The World Health Association recommends that mothers continue to breast-feedup to two years of age. However, the AAP recommends that mothers continue to breast-feed forat least one year of age for best results in the development of their child.Cigarette smoking has become a very controversial issue in the last twenty years. In astudy done by Newcomb et al. it was "found that cigarette, alcohol, and cannabis showed thesame pattern of association with increasing level of risk factors." A longitudinal study on thereasons for smoking in adolescence points out that each of these, including cigarette smoking, donot have one particular "pathway" in which each begin, but have many factors for its onset.Reasons for smoking given by many adolescents include relaxation, pleasure, and impressingothers (McGee and Stanton, 1993). In this same study there were also reasons that state whyadolescents do not smoke, such as damage to health, parental influence, and cost (McGee andStanton). In a study using adults as the population, it was found that relaxation was also a reasonfor smoking. Psychological and physical addictions were also specified as motivations forsmoking (Jenks, 1994). A study done by Holger Schmid, Ph.D, illustrated the "stages-of-changein smoking cessation and nicotine addiction." It gave evidence that teenagers who statedsmoking in their mid-teens, who had "negative feelings" and low self-esteems were more likelyto become addicted to the nicotine, and continue to smoke into their later teen years. One otherimportant factor in smoking is modeling. Parents, siblings, friends, and celebrities all influence

Breastfeeding and Smoking 5an individual in smoking (Schmid, 2001). "Particularly for such addictive behavior as cigarettesmoking, movement through the stages involves progression and regression." Schmid makes areference to the trans-theoretical theory that describes a "forward movement" through the stages"more probable than a backward movement." Ultimately Schmid found that older male studentswho had low self-image, at least one parent who smoked and a "lower perception of danger"were more likely to smoke more often than their counterparts. Today in the U.S., smoking islooked down upon and is seen as a vice. People tend to attribute [cigarette] smoking to addictionand psychological explanations.According to Sigmund Freud, smoking is an outlet that is controlled by theunconscious, which is " a particular realm of the mind with its own wishful impulses, its ownmode of expression and its particular mental mechanisms which are not in force elsewhere"(Jacobs, 1992). The term "oral fixation" is described by Freud as a fulfillment (orally) thatpleases the unconscious and makes up for the earlier inability to leave the oral stage ofdevelopment (Jacobs 1992). Freud`s theory of development consists of three stages: oral, anal,and genital stages. Freud later added the "phallic" stage, labeling it as a pre-genital stage. Theoral stage lasts from birth until one year of age. An infant`s pleasure is received fromstimulation of the mouth (Badcock 1988). The failure to progress past this stage results in anoral fixation. Freud speaks a great deal about the "sexual aim of the infantile instinct" sayingthat it "consists in obtaining satisfaction by means of an appropriate stimulation of the erotogeniczone which has been selected in one way or another" (Jacobs 1992). A sexual object that is keyto the body represents each stage: the mouth, anus, and the genitals. During the oral stage,insufficient breastfeeding or too much gratification can lead to a fixation later in life (Badcock1988). Freud considered weaning to be a "universal trauma". Being weaned from the breast is

Breastfeeding and Smoking 6seen as a trauma only if the child has become addicted to the breast (Badcock 1988). Badcockadds that "we do not miss the things we do not want" insinuating that the weaned infant comes tomiss the oral contact of the breast and substitutes the nipple for other objects throughout its life.Other objects that become part of oral fixations are fingers, the thumb (sucking, nail biting) andcigarettes.Badcock sums up this stage well when he says, "Freud concluded that, even thoughoral pleasure and nutritive need might initially be one and the same, it very quickly emerges thatoral sensations can become sensually pleasurable in themselves." Cigarette smoking, as an oralfixation, is very pleasurable in itself. This is one of the reasons why smokers continue to besmokers. It is very pleasurable and relaxing, just as thumb sucking relaxes young children, justas breastfeeding soothes a hungry infant. The intentions of this study is to find a relationshipbetween breastfeeding and cigarette smoking, more specifically, that the duration ofbreastfeeding is correlated with smoking later in life.MethodsParticipantsEighty-seven undergraduate students (41 male, 46 female) were recruited through randomselection and convenience sampling from Loyola University New Orleans. Participants werechosen not based on race, gender, or religious affiliation. Participants were between the ages of18 and 22. The researchers recruited participants through different organizations on campus aswell as friends of the researchers. An informed consent form was required to be signed by allparticipants. Upon completion of the survey the researcher debriefed the participants.MaterialsThe participants signed two informed consent forms (see appendix A; one for their

Breastfeeding and Smoking 7records and one for themselves to keep for proof of voluntary participation and informationregarding the study). These forms gave the investigators` names and email addresses, in case theparticipants needed to get in touch with the investigator at any time. The number of the campuscounseling services was also on the consent form in case needed. The informed consent formsbriefly outlined the study and made the participants aware of their rights and safety.The participants then filled out a survey created by the investigator (see appendix B).The first question asked the participant`s demographic information (i.e. age, sex...). The next setof questions concerned the participants smoking habits. These questions were designed tounderstand if a person smoked, when they began, and how they smoked. The final sectionconsisted of two, brief questions asking if the participant was breastfed and if so for how long.Due to the nature of the breastfeeding questions and the likelihood that everyparticipant will not know the answer, a phone will be available so that the participant may callwhom ever would know the answer.Design and ProcedureThe current study was non-experimental self-report as it examined the relationshipbetween the duration of breast-feeding and the incidence of smoking later in life. Variable onewas the participants smoking habits, i.e. if they were a smoker, how often they smoked... etc.This was measured through a series of questions asking the participant to answer truthfully.Variable two is breastfeeding duration (the length, in months of the subjects` breastfeedinghistory). This was also measured through questions asking the duration of their breast-feedingspan.The investigators, either all or some, met the participants on Loyola University NewOrleans campus in a previously selected classroom or location convenient to both the principal

Breastfeeding and Smoking 8investigator and the participant. The study, as well as the investigators were introduced to theparticipants and answered any questions the participants had. The two informed consent formswere then given to the participants and fully explained. After the participants read the consentforms they signed them and gave one back to the investigators. After the investigators had asigned consent form from each of the participants, the survey was passed out. The participantswere then informed that for the two questions regarding breastfeeding, if they did not know theanswer, they were allowed to use the phone provided to call someone with the correct response.After each of the participants finished the survey they were told the entire study and theinvestigators hypothesis. Then the participants were told that if they felt any distress regardingthis survey they were to contact campus-counseling services. The participants were then thankedand dismissed by the investigators.ResultsA one-way ANOVA was used to show the mean statistics of the variables in the study.The average age of the subjects was 19.69, with a standard deviation of 1.08. Of the 87participants, 78.2 were breastfed (n=68) with an average duration of 7.98 months (SD= 5.82).Of the non-smokers, 18.4 smoked for at least one point in their lives with a mean starting ageof 16.2 (standard deviation of 1.97) and a mean quitting age of 17.72 (SD= 1.75).We separated the finished surveys into three groups, average (6-9 months), high (>9months), or low (<6 months), based on the mean rates of the participants` responses to thequestion about the duration of breastfeeding. The research hypothesis was that there would be adifference between the low, average and high duration groups on whether or not they smoked.Our data shows us that our hypothesis was not supported. Our results showed that there was nota significant difference between these groups, F (2,67)=. 337 ns. There was also no difference

Breastfeeding and Smoking 9between the breast-feeding groups in terms of the age they started smoking F (2,45)= .169 ns.One interesting detail found was that the majority of current smokers smoke only when drinking(21.8; n=19) and 71.3 (n=62) of smokers do not buy their own cigarettes. The Pearson t-testshowed that p> .05 in the cases of a correlation between the duration of breastfeeding andsmoking, a correlation between the incidence of breastfeeding and smoking, and a correlationbetween a family member smoking and the participant smoking. One surprising aspect seen inthe Pearson correlation is that there was no significant relationship between a family membersmoking and the subject smoking (r= -.069 ns) nor was there a relationship between a familymember smoking and the age of the subjects when they started smoking (r= -.081 ns).DiscussionCigarette smoking is common among Americans, especially college students. There ismuch information and data as to why people smoke and also what causes smoking. Physical aswell as psychological factors are associated with smoking. In our study we tried to focus moreon one particular psychological factor for smoking such as oral fixations. We hypothesized thatthe duration of breastfeeding, whether average (6-9 months), high (>9 months), or low (<6months) would correlate with the incidence of smoking in later life (college for our sample).Meaning that if you were not breastfed enough or for too long, an oral fixation resulted, i.e.,smoking. Unfortunately, our data did not support our hypothesis. Problems with our study werea small sample size and insufficient empirical evidence. We hoped to get 100 Loyolaundergraduate participants, however; only 87 participated. One major problem we encounteredwas the lack of similar studies done correlating breastfeeding and smoking in the subject. Therewas plenty of evidence and studies completed on the harmful effects of maternal smoking duringthe course of breastfeeding (Pugh, Milligan, Frick, Spatz and Bronner 2002). However there

Breastfeeding and Smoking 10were no studies completed on the duration of breastfeeding being a cause or correlate forsmoking. In gathering previous data for our study, were only able to use research and studiesthat spoke either about causes effects, and predictors of smoking. If this study had producedsignificant results, we hoped the practical implications for our research would be moreinformation helpful in decreasing smoking habits among college students, and also help inpreventing these habits before they started. Hopefully the theoretical implications for our studyare an increased amount of information on this topic and an awareness of the psychologicalmotivations for smoking. We also hope that this study poses questions and examinations onFreud`s psychosexual theory of development and oral stages. A suggestion for future researcherswould be to collect a larger sample size. It is possible that more significant relationships couldbe found if there were a larger number of participants studied. Overall, I think this study wassuccessful in the fact that it was original. It also sets a foundation (such as the suggestions forcollecting a larger sample, and using our research to build on other ideas such as relationshipsbetween certain oral fixations, the incidence of smoking as a fixation, etc.) for other researcherswho are interested in this or related topics.

Breastfeeding and Smoking 11ReferencesBadcock, C. (1988). Essential Freud. Oxford, UK: Basil Blackwell, Ltd.Pugh, L.C., Milligan, R.A., Frick, K.D.,Spatz, D., & Bronner, Y. (2002). Breastfeeding duration,costs, and benefits of a support program for low-income breastfeeding women. Birth, 29,95-100.Jacobs, M. (1992). Sigmund Freud. London, England: Sage Publications, Ltd.Jenks, R.J. (1994). Smoking and satisfaction and motivation: A comparison of men and women.Journal of Social Psychology, 134, 847-849.McGee, R. & Stanton, W. R. (1993). A longitudinal study of reasons for smoking inadolescence. Addiction, 55,265-271.Quinn, P.J., O`Callaghan, M.O., Williams, G.M., Najman, J.M., Anderson, M.J., & Bor, W.(2001). The effect of breastfeeding on child development at 5 years: A cohort study.Journal of Pediatrics and Child Health, 37, 465-469.Schmid, H. (2001). Predictors of cigarette smoking by young adults and readiness to change.Substance Use & Misuse, 36, 1519-1542.Schwartz, K., D`Arcy, H.J.S., Gillespie, B., Bobo, J., Longway, M., & Foxman, B. (2002).Factors associated with weaning in the first 3 months postpartum. The Journal of FamilyPractice, 51, 439-444.Breastfeeding and Smoking 12

Principal Investigators:

Appendix A

Informed ConsentA Study of breastfeeding and smoking

Marie Rose Bobel (mrbobel@loyno. edu)Erin Raith (ecraith@loyno. edu)Whitney B. Torres (wbtorres@loyno.edu)Faculty Supervisors:Elizabeth A. Deitch, Ph.D (eadeitch@loyno. edu)Elizabeth Yost Hammer, Ph.D (eyhammer@lovno.edu)Description of the Research: The study is on breastfeeding and smoking.Procedures: If you are to agree to participate in this study, you will be asked to respond to a setof questions pertaining to the length of your being breastfed and your smoking habits. This willtake approximately 10 minutes.Benefits and Risks: The only individual risk is that one might feel that the questions areintrusive. The benefits, if our hypothesis is supported, will help understand breastfeeding andsmoking habits. If you feel the need to, you may contact the Counseling and Career Services,208 Dana Center, (504) 865-3835.Research and Date Records: Records of your participation in this study will be keptconfidential to the extent permitted by the law. Your responses and results will only be reportedanonymously as summarized data and will not contain any identifiable data.Voluntary Participation: Your participation in this study is completely voluntary. At any pointduring the survey, you may withdraw your consent and terminate your participation withoutconsequence. Should you have any questions, you may contact one of the principal investigatorsby email.By signing below, you agree that you have been sufficiently informed of the purpose of the studyand any risks and benefits. Please sign the two copies and keep one for yourself and give theprincipal investigators the other copy for our records.I have read and understand the information given above, and I sign this consent formwillingly.\

Signature ofParticpant_______________Date_________ Breastfeeding and Smoking 13Appendix BSurvey1.) How old are you? ____2.) Sex? ____3.) Does anyone in your family smoke cigarettes? Circle: YES or NOIf yes, relationship_________4.) Do you currently smoke cigarettes? Circle: YES or NO (only circle NO is you donot ever smoke)5.) Which best describes your smoking style? (Circle one)a. smoke everyday b. only on the weekends c. only when drinking d. only whenavailable e. other _______(please specify)6.) Do you buy cigarettes for yourself? Circle YES or NO7.) At what age did you start smoking?______8.) If you currently smoke or have never smoked, skip to question 12.If you do not currently smoke, have you ever smoked for a period in your life?Circle: YES or NO9.) At what age did you start? _______10.) At what age did you quit?________11.) Why did you quit?12.) Were you breasted? Circle: YES or NO13.) If so, until what age? (please answer in terms of months)__________