National Level

Measuring the impact of maternal smoking must begin with measuring the prevalence of smoking during pregnancy. In the national section data on the following key measures are presented:

• The percentage of women smoking during pregnancy in 1999, by race/ethnicity, age, and education (Figure 1). The data source is the birth certificate.
• Infant birth weight, by mother's smoking status in 1998 (Figure 2). The data source is the birth certificate.
• The percentage of women smoking during pregnancy in 1999, by state (Figure 3). The data source is the Pregnancy Risk Assessment Monitoring System (PRAMS).
• The percentage of women smoking during pregnancy between 1989 and 1999 (Figure 4). The data source is the birth certificate.
• The percentage of women aged 25 and older who smoked during pregnancy in 1999, by race/ethnicity and years of education (Figure 5). The data source is the birth certificate.
• The percentage of women smoking during pregnancy, by state of residence and percentage change between 1989 and 1999 (Table). The data source is the birth certificate.

State Level

The state section includes the same measures of the percentages of women smoking during pregnancy as in the national section (Figures 1 and 2). Additional data included in the state section are described below and in the "Any State" section.

Health Effects of Smoking During Pregnancy

Maternal smoking clearly affects the infant's health at birth. The measures of health effects presented here were estimated using a beta version of the Maternal and Child Health Smoking-Attributable Mortality, Morbidity, and Economic Costs (MCH SAMMEC) software package.¹² This databook includes the following indicators of smoking-related infant health problems:

• Deaths from SIDS.
• Percentage of infants with low birth weight (<2500 grams).
• Percentage increase in the probability of admission to a neonatal intensive care unit at delivery.
• Nights in hospital during delivery stay.
• Percentage of neonatal health care dollars.
• Total neonatal health care dollars.

Birth Statistics

While most of the data in this databook are related only to mothers who smoke, additional data on all live births in the state are presented to provide a broader context. The data source for the percentage of Women, Infants, and Children (WIC) program participants is PRAMS. The data source for all other information is the birth certificate. Summary data for all live births in 1999 include

• Total live births.
• Mean birth weight for all live births.
• Percentage of all live births with low birth weight (<2500 grams).
• Percentage of WIC participants.
• Percentage with first trimester prenatal care.
• Percentage of total live births by race/ethnicity, age of mother, and years of maternal education.

Programs and Policies

Numerous state and federal policies and programs are intended to improve maternal and infant health. Most of these programs also provide an avenue for addressing smoking cessation among pregnant women.

If a smoking mother is low-income, for example, she is likely to qualify for Medicaid coverage, and hence the costs of the adverse outcomes are likely to fall on the state's Medicaid program. Although Medicaid programs are required to cover pregnant women who have an income up to 133% of the federal poverty level, many states go beyond this limit. In 1999, 37 states exceeded this requirement. To highlight the differences in these policies among the states, this databook includes

• Medicaid eligibility income levels (2000) for pregnant women.
• Estimated percentage of all 1998 births covered by Medicaid.

The latter indicator provides information on the relative impact that smoking among low-income pregnant women might have on states' Medicaid budgets.

While the federal government shares in the costs of Medicaid with the states, it also helps them address the needs of low-income pregnant women through other grant programs. This databook provides information for each state on two important federal programs:

• Federal grant dollars for WIC (2001).
• Federal Title V grant dollars (2001).

Other state/federal policies, specifically those related to cigarette excise taxes, can affect the number of women who smoke during pregnancy. These excise taxes are potential sources of revenue for initiating smoking cessation interventions. Included in this databook are several indicators related to state tobacco excise tax policy in 2001:

• State tobacco excise tax per pack.
• Federal and state tobacco excise tax as a percentage of price.
• State annual tobacco excise tax revenue.

In addition to setting excise tax rates on cigarettes, states can initiate clean indoor air policies that regulate smoking in environments that could affect pregnant women or infants. This databook highlights the following:

• Regulation of smoking in commercial day care settings.
• Regulation of smoking in home-based day care settings.

The Master Settlement Agreement (MSA) between 46 states' attorneys general and the tobacco industry also has provided states with revenue (Mississippi, Texas, Florida, and Minnesota settled their lawsuits on their own). States have considerable flexibility in how they spend tobacco settlement funds. Although CDC and others have begun to systematically document how states are using these funds, the amount used to specifically address issues related to maternal smoking is not yet being tracked. This databook presents

• Each state's MSA dollars in 2001.
• Actual MSA dollars allocated to tobacco control programs in 2001.

Funding for tobacco control programs comes from within the state or from federal or national sources. Each state can choose to allocate funds from state excise tax revenues, the MSA, or other revenue streams, including federal and private grant funds. Federal support comes from the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration. Private grant funds are provided by the Robert Wood Johnson and American Legacy foundations. Included for 2001 are

• Total dollars for tobacco control programs from all sources.

MCH Smoking Cessation Programs

States can also influence behavior through publicly funded smoking cessation programs. This databook includes a summary of states' efforts to screen Maternal and Child Health (MCH) clients and educate them about the adverse effects of smoking during pregnancy. Specifically, yes/no indicators are included for the following:

• Screening clients at public clinics.
• Providing counseling to clients receiving publicly funded perinatal services.
• Providing cessation materials to pregnant smokers.
• Having media campaigns targeting pregnant women.
• Training MCH professionals on delivering smoking cessation interventions.
• Reimbursing clients through Medicaid for smoking cessation counseling or nicotine replacement therapy or both.

Together, the state indicators provide a state-by-state comparison of the scope of the problem of maternal smoking, the range of related outcomes, and information on state and federal policies that are aimed at improving maternal/infant health and that could incorporate screening and smoking cessation programs for low-income pregnant women.

Date last reviewed: 03/29/2006
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion