Reducing prenatal smoking: the role of state policies.
BACKGROUND
Maternal smoking causes adverse health outcomes for both mothers and infants and leads to excess healthcare costs at delivery and beyond. Even with substantial declines over the past decade, around 23% of women enter pregnancy as a smoker and though almost half quit during pregnancy, half or more quitters resume smoking soon after delivery.


OBJECTIVE
To examine the independent effects of higher cigarette taxes and prices, smokefree policies, and tobacco control spending on maternal smoking prior to, during, and after a pregnancy during a period in which states have made changes in such policies.


METHODS
Data from pooled cross-sections of women with live births during 2000-2005 in 29 states plus New York City (n=225,445) were merged with cigarette price data inclusive of federal, state, and local excise taxes, full or partial bans on smoking in public places, and tobacco control spending. Probit regression models using a mixed panel, state fixed effects, and time indicators were used to assess effect of policies on smoking (during 3 months before pregnancy); quitting by last 3 months of pregnancy; and having sustained quitting at the time of completing the postpartum survey.


RESULTS
Multivariate analysis indicated that a $1.00 increase in taxes and prices increases third-trimester quits by between 4 and 5 percentage points after controlling for the other policies and covariates. Implementing a full private worksite smoking ban increases quits by the third trimester by an estimated 5 percentage points. Cumulative spending on tobacco control had no effect on pregnancy smoking rates overall. Association of tobacco control policies with maternal smoking varied by age.


CONCLUSIONS
States can use multiple tobacco control policies to reduce maternal smoking. Combining higher taxes with smokefree policies particularly can be effective.
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. eadam01@emory.edu
E Kathleen
EK
Adams
Sara
S
Markowitz
Viji
V
Kannan
Patricia M
PM
Dietz
Van T
VT
Tong
Ann M
AM
Malarcher
D000328:Adult; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D015999:Multivariate Analysis; D009519:New York City; D011159:Population Surveillance; D011247:Pregnancy; D011295:Prenatal Care; D012907:Smoking / Q000191:economics / Q000331:legislation & jurisprudence; D000074606:Smoking Prevention; D013219:State Government; D013660:Taxes / Q000331:legislation & jurisprudence; D014481:United States