Whitney B. Torres

Loyola University New Orleans

Breastfeeding and Smoking 2

Abstract

Sigmund Freud is widely known for his psychosexual stages of development. He believed that if

these 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 oral

stage. We believed that earliest form of oral pleasure, breastfeeding, would have a connection

with an oral fixation that can occur later in life (smoking). We hypothesized that the duration of

breastfeeding, whether too long or too short would have some kind of effect with the incidence

of smoking later in life. Eighty-seven undergraduate participants were sampled from Loyola

University in New Orleans. The participants were between the ages of 18 and 22 years and were

male (n=41) and female (n-46). The participants were given a questionnaire to fill out that

contained questions concerning the incidence and duration of breastfeeding and smoking

behaviors. Our independent variable was the duration of breastfeeding and our dependent

variable was smoking or smoking behaviors. The results of our research proved to be

inconclusive. We could not find a relationship between these two variables, but we hope that our

research could be used as a foundation for other researchers who are interested in this or related

topics.

Breastfeeding and Smoking 3

The Correlation Between the Duration of Breastfeeding and Smoking in Later Life

The topic of breastfeeding is and always has been very debatable. Biologically

speaking, extended research has shown the many benefits of breastfeeding. A cohort

longitudinal study was done on the effects of breastfeeding on a child`s development at five years

after their participation in this study began (at birth). A positive relationship was found between

the PPV-T scores and the duration of breastfeeding with an increased number on the tests as the

duration of breastfeeding was increased (Quinn, 2001). This is just one of the many studies that

show the positive effects of breastfeeding and adequate duration. One of the reasons why many

American mothers have a significantly lower breast-feeding duration is because of social views

and societal norms. Today in the U.S. many people would be startled to see a four-year-old

nursing at his/her mother`s breast. This is one reason why American mothers wean their children

earlier than mothers of other cultures. There are other reasons why American mothers wean their

infants earlier. According to a study on the factors associated with weaning in the first three

months, conducted by researchers in Michigan and Nebraska, younger and less educated women

tend to breastfeed their infants for a shorter amount of time than other women. This is due to the

lack of support and education in breastfeeding. Three factors in the cessation of breastfeeding

are 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 a

shorter amount of time, in terms of months (Schwartz, 2002). Not only are the cognitive benefits

of breastfeeding high, but so are the economical benefits. In a study funded by the National

Institute of Nursing Research, the researchers recognize this fact. One key point the researchers

bring 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 empowering

and helps with pregnancy spacing.. .may also save the mother and society resources\" such as

food 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 months

of age, and 16 percent nurse until one year of age. Global views of breast-feeding vary

significantly. The World Health Association recommends that mothers continue to breast-feed

up to two years of age. However, the AAP recommends that mothers continue to breast-feed for

at 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 a

study done by Newcomb et al. it was \"found that cigarette, alcohol, and cannabis showed the

same pattern of association with increasing level of risk factors.\" A longitudinal study on the

reasons for smoking in adolescence points out that each of these, including cigarette smoking, do

not 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 impressing

others (McGee and Stanton, 1993). In this same study there were also reasons that state why

adolescents do not smoke, such as damage to health, parental influence, and cost (McGee and

Stanton). In a study using adults as the population, it was found that relaxation was also a reason

for smoking. Psychological and physical addictions were also specified as motivations for

smoking (Jenks, 1994). A study done by Holger Schmid, Ph.D, illustrated the \"stages-of-change

in smoking cessation and nicotine addiction.\" It gave evidence that teenagers who stated

smoking in their mid-teens, who had \"negative feelings\" and low self-esteems were more likely

to become addicted to the nicotine, and continue to smoke into their later teen years. One other

important factor in smoking is modeling. Parents, siblings, friends, and celebrities all influence

Breastfeeding and Smoking 5

an individual in smoking (Schmid, 2001). \"Particularly for such addictive behavior as cigarette

smoking, movement through the stages involves progression and regression.\" Schmid makes a

reference 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 students

who 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 is

looked down upon and is seen as a vice. People tend to attribute [cigarette] smoking to addiction

and psychological explanations.

According to Sigmund Freud, smoking is an outlet that is controlled by the

unconscious, which is \" a particular realm of the mind with its own wishful impulses, its own

mode 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) that

pleases the unconscious and makes up for the earlier inability to leave the oral stage of

development (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. The

oral stage lasts from birth until one year of age. An infant`s pleasure is received from

stimulation of the mouth (Badcock 1988). The failure to progress past this stage results in an

oral fixation. Freud speaks a great deal about the \"sexual aim of the infantile instinct\" saying

that it \"consists in obtaining satisfaction by means of an appropriate stimulation of the erotogenic

zone which has been selected in one way or another\" (Jacobs 1992). A sexual object that is key

to 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 (Badcock

1988). Freud considered weaning to be a \"universal trauma\". Being weaned from the breast is

Breastfeeding and Smoking 6

seen as a trauma only if the child has become addicted to the breast (Badcock 1988). Badcock

adds that \"we do not miss the things we do not want\" insinuating that the weaned infant comes to

miss 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) and

cigarettes.

Badcock sums up this stage well when he says, \"Freud concluded that, even though

oral pleasure and nutritive need might initially be one and the same, it very quickly emerges that

oral sensations can become sensually pleasurable in themselves.\" Cigarette smoking, as an oral

fixation, is very pleasurable in itself. This is one of the reasons why smokers continue to be

smokers. It is very pleasurable and relaxing, just as thumb sucking relaxes young children, just

as breastfeeding soothes a hungry infant. The intentions of this study is to find a relationship

between breastfeeding and cigarette smoking, more specifically, that the duration of

breastfeeding is correlated with smoking later in life.

Methods

Participants

Eighty-seven undergraduate students (41 male, 46 female) were recruited through random

selection and convenience sampling from Loyola University New Orleans. Participants were

chosen not based on race, gender, or religious affiliation. Participants were between the ages of

18 and 22. The researchers recruited participants through different organizations on campus as

well as friends of the researchers. An informed consent form was required to be signed by all

participants. Upon completion of the survey the researcher debriefed the participants.

Materials

The participants signed two informed consent forms (see appendix A; one for their

Breastfeeding and Smoking 7

records and one for themselves to keep for proof of voluntary participation and information

regarding the study). These forms gave the investigators` names and email addresses, in case the

participants needed to get in touch with the investigator at any time. The number of the campus

counseling services was also on the consent form in case needed. The informed consent forms

briefly 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 set

of questions concerned the participants smoking habits. These questions were designed to

understand if a person smoked, when they began, and how they smoked. The final section

consisted 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 every

participant will not know the answer, a phone will be available so that the participant may call

whom ever would know the answer.

Design and Procedure

The current study was non-experimental self-report as it examined the relationship

between the duration of breast-feeding and the incidence of smoking later in life. Variable one

was 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` breastfeeding

history). This was also measured through questions asking the duration of their breast-feeding

span.

The investigators, either all or some, met the participants on Loyola University New

Orleans campus in a previously selected classroom or location convenient to both the principal

Breastfeeding and Smoking 8

investigator and the participant. The study, as well as the investigators were introduced to the

participants and answered any questions the participants had. The two informed consent forms

were then given to the participants and fully explained. After the participants read the consent

forms they signed them and gave one back to the investigators. After the investigators had a

signed consent form from each of the participants, the survey was passed out. The participants

were then informed that for the two questions regarding breastfeeding, if they did not know the

answer, 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 the

investigators hypothesis. Then the participants were told that if they felt any distress regarding

this survey they were to contact campus-counseling services. The participants were then thanked

and dismissed by the investigators.

Results

A 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 87

participants, 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 age

of 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 (>9

months), or low (<6 months), based on the mean rates of the participants` responses to the

question about the duration of breastfeeding. The research hypothesis was that there would be a

difference 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 not

a significant difference between these groups, F (2,67)=. 337 ns. There was also no difference

Breastfeeding and Smoking 9

between 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-test

showed that p> .05 in the cases of a correlation between the duration of breastfeeding and

smoking, a correlation between the incidence of breastfeeding and smoking, and a correlation

between a family member smoking and the participant smoking. One surprising aspect seen in

the Pearson correlation is that there was no significant relationship between a family member

smoking and the subject smoking (r= -.069 ns) nor was there a relationship between a family

member smoking and the age of the subjects when they started smoking (r= -.081 ns).

Discussion

Cigarette smoking is common among Americans, especially college students. There is

much information and data as to why people smoke and also what causes smoking. Physical as

well as psychological factors are associated with smoking. In our study we tried to focus more

on one particular psychological factor for smoking such as oral fixations. We hypothesized that

the duration of breastfeeding, whether average (6-9 months), high (>9 months), or low (<6

months) 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 were

a small sample size and insufficient empirical evidence. We hoped to get 100 Loyola

undergraduate participants, however; only 87 participated. One major problem we encountered

was the lack of similar studies done correlating breastfeeding and smoking in the subject. There

was plenty of evidence and studies completed on the harmful effects of maternal smoking during

the course of breastfeeding (Pugh, Milligan, Frick, Spatz and Bronner 2002). However there

Breastfeeding and Smoking 10

were no studies completed on the duration of breastfeeding being a cause or correlate for

smoking. In gathering previous data for our study, were only able to use research and studies

that spoke either about causes effects, and predictors of smoking. If this study had produced

significant results, we hoped the practical implications for our research would be more

information helpful in decreasing smoking habits among college students, and also help in

preventing these habits before they started. Hopefully the theoretical implications for our study

are an increased amount of information on this topic and an awareness of the psychological

motivations for smoking. We also hope that this study poses questions and examinations on

Freud`s psychosexual theory of development and oral stages. A suggestion for future researchers

would be to collect a larger sample size. It is possible that more significant relationships could

be found if there were a larger number of participants studied. Overall, I think this study was

successful in the fact that it was original. It also sets a foundation (such as the suggestions for

collecting a larger sample, and using our research to build on other ideas such as relationships

between certain oral fixations, the incidence of smoking as a fixation, etc.) for other researchers

who are interested in this or related topics.

Breastfeeding and Smoking 11

References

Badcock, 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 in

adolescence. 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 Family

Practice, 51, 439-444.

Breastfeeding and Smoking 12

Principal Investigators:

Appendix A

Informed Consent

A 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 set

of questions pertaining to the length of your being breastfed and your smoking habits. This will

take approximately 10 minutes.

Benefits and Risks: The only individual risk is that one might feel that the questions are

intrusive. The benefits, if our hypothesis is supported, will help understand breastfeeding and

smoking 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 kept

confidential to the extent permitted by the law. Your responses and results will only be reported

anonymously as summarized data and will not contain any identifiable data.

Voluntary Participation: Your participation in this study is completely voluntary. At any point

during the survey, you may withdraw your consent and terminate your participation without

consequence. Should you have any questions, you may contact one of the principal investigators

by email.

By signing below, you agree that you have been sufficiently informed of the purpose of the study

and any risks and benefits. Please sign the two copies and keep one for yourself and give the

principal investigators the other copy for our records.

I have read and understand the information given above, and I sign this consent form

willingly.

\\

Signature ofParticpant_______________Date_________

Breastfeeding and Smoking 13

Appendix B

Survey

1.) How old are you? ____

2.) Sex? ____

3.) Does anyone in your family smoke cigarettes? Circle: YES or NO

If yes, relationship_________

4.) Do you currently smoke cigarettes? Circle: YES or NO (only circle NO is you do

not 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 when

available e. other _______(please specify)

6.) Do you buy cigarettes for yourself? Circle YES or NO

7.) 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 NO

9.) 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 NO

13.) If so, until what age? (please answer in terms of months)__________