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Smoking and Pregnancy

Smoking and Pregnancy

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Smoking and Pregnancy

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  1. Smoking and Pregnancy 12/3/12

  2. Smoking and Pregnancy: Why is it a public health problem? • Cigarette smoking during pregnancy: • is one of the most common preventable causes of infant morbidity and mortality • increases the risk for pregnancy complications and poor outcomes • is associated with adverse outcomes for children

  3. Epidemiology • Risk factors include: race, age, education • AI>White>Black • Adolescents> 25 years or older • High school graduates> college graduates • In 2009, 9.3% of all mothers smoked during pregnancy: • 30% of small-for-gestational age infants • 10% of preterm infants • 5% infant deaths • 776 infants deaths annually (2000-2004)

  4. Prevention

  5. Current Availability/Utilization • Smoking-attributable neonatal health care costs, in 2004: 148.5 million • Increased hospital stays, years of life lost, and cost burden

  6. Intervention Cost • Smoking cessations intervention program cost $24-34 and saves $881 per U.S. pregnant smokers • net savings of up to $8 million • Cessation programs: • reduce number of low birth weight babies • reduce use of ICU • shorten length of hospital stays • decrease service intensity

  7. Intervention Outcomes • A review of clinical outcomes for pregnant women who quit smoking revealed: • a 20% reduction in the number of low-birth-weight babies • a 17% decrease in preterm births • an average increase in birth weight of 28g

  8. Policy: ACA • 2010: all states required to offer comprehensive tobacco cessation coverage for pregnant women with no regard to co-payments • 2013: increased reimbursement for states that provide tobacco services • 2014: state programs may not exclude tobacco cessation medications from coverage

  9. Life Course Model • Smoking while pregnant: • makes women and their children more vulnerable to health and behavioral problems • secondarily affects other children/ offspring

  10. MCH Leadership • need for prevention and support that focuses on health mother and child: • collaborations among agencies that focus on early intervention • collaborations among health professionals and networks for continuity and comprehensive patient care • reduction of negative risk factors

  11. MCH Leadership • Also needed is: • increased public and media awareness and coverage of women’s and children’s • advocacy efforts similar to those seen with breast cancer • research that focuses on gender specific outcomes • implementation and evaluation of state/ national prevention and smoking cessation programs

  12. In conclusion smoking among pregnant women continues to be a public health concern. However, with more specific interventions, collaborations, and strategies, smoking among pregnant women can be greatly reduced.

  13. References • Ayadi, Costs of Smoking Cessation Counseling Intervention for Pregnant Women; Public Health Rep 2006; 121:120-6. • CDC. Annual smoking-attributable mortality, years of potential life lost, and economic costs---United States, 1997--2001. MMWR 2005;54:625--8. • CDC. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services,CDC;2004.Available at http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/index.htm • Child Trends (2012). Mothers Who Smoke While Pregnant. Retrieved from www.childtrendsdatabank.org/?q=node/241. • Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women, Topic Page. April 2009. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac2.htm • Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Fox BJ, Goldstein MG, et al. Treating tobacco use and dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; 2000. Accessed at http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf on 31 March, 2009. • Hall JR Jr. The smoking-material fire problem. Quincy, MA: National Fire Protection Association, Fire Analysis and Research Division; 2007. Child Trends (2012). Mothers Who Smoke While Pregnant. Retrieved from www.childtrendsdatabank.org/?q=node/241. • Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC): Maternal and Child Health (MCH) SAMMEC software, CDC, 2004, retrieved from https://apps.nccd.cdc.gov/sammec/mch_dhccexp.asp • US Department of Health and Human Services, Tobacco Use and Dependence Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. Rockville (MD):; 2008 May. 4, Intensive Interventions for Tobacco Use and Dependence. Available from: http://www.ncbi.nlm.nih.gov/books/NBK63953/

  14. Questions?