Balancing absolute and relative risk reduction in tobacco control policy: the example of antenatal smoking in Victoria, Australia.
OBJECTIVE
This descriptive epidemiological analysis aims to explore the benefits, risks and policy balance between a whole-of-population and high-risk reduction approach to reducing antenatal smoking prevalence.


METHODS
Using Victorian hospital antenatal statistics the rate-ratio for smoking in each hypothesised high prevalence group was calculated and combined with the absolute number of births in each high-risk group. The effect on smoking prevalence of whole-of-population reductions and high-risk group reductions was then modelled.


RESULTS
In Victoria, there were higher rates of antenatal smoking among single [RR = 4.67 (3.46-4.42)], teenage women [RR (95%CI) = 3.26 (3.00-3.54)] of indigenous ethnicity [RR = 4.39 (3.94, 4.88)] with low income [RR = 4.67 (4.17-5.22)] and low education attainment [RR = 3.89 (3.47-4.36)] who lived in less accessible areas [RR = 2.14 (1.92-2.39)]. However, as each of these high-risk groups represents a relatively small proportion of mothers, most antenatal smokers are aged 25-34, educated, city-based, non-Indigenous and non-impoverished.


CONCLUSIONS
The majority of Victorian women who smoke in pregnancy do not belong to traditional high-risk groups.


CONCLUSIONS
Absolute reductions in smoking prevalence in high-risk groups can potentially be achieved by whole-of-population prevalence reductions, despite a potential continuance in high relative risk among these groups. Conversely, an exclusive focus on smoking reduction in high-risk groups may fail to reduce the whole-of-population antenatal smoking prevalence.
Grills
Nathan
N
Victorian Public Health Training Scheme, Victorian Department of Health and School of Public Health and Preventative Medicine, Monash University, Victoria. nathangrills@gmail.com
Bolam
Bruce
B
Piers
Leonard Sunil
LS
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D004812:Epidemiologic Methods; D005260:Female; D006291:Health Policy; D006801:Humans; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult; D014026:Nicotiana