title: Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use.
abstract: OBJECTIVE
  Previous estimates of smoking-attributable adverse outcomes, such as preterm births (PTBs), low birth weight (LBW) and Sudden Infant Death Syndrome (SIDs) generally do not address disparities by maternal age, racial/ethnic group or socioeconomic status (SES). This study develops estimates of smoking-attributable PTB, LBW and SIDS for the US by age, SES and racial/ethnic groupings.
  
  
  METHODS
  Data on the number of births and the prevalence of PTB, LBW and SIDS were used to develop the number of outcomes by age, race/ethnicity, and SES. The prevalence of prenatal smoking by age, race/ethnic and education and the relative risk of outcomes for smokers were used to calculate smoking-attributable fractions of outcomes.
  
  
  RESULTS
  Prenatal smoking among ages 15-24 is above 12 %, with 20-24 year olds representing at least 35 % of PTB, LBW SIDS cases. Women with a high school education or less represented more than 50 % of PTB and LBW births, and 44 % of SIDS cases. While non-Hispanic Whites had the majority of smoking-attributable outcomes, non-Hispanic Blacks represented a disproportionately high percentage of PTBs (18 %), LBW births (22 %), and SIDS cases (13 %).
  
  
  CONCLUSIONS
  Reducing prenatal smoking has the potential to reduce adverse birth outcomes and costs with long-term implications, especially among the young, non-Hispanic Blacks and those of lower SES. Stricter tobacco control policies, especially higher cigarette taxes, higher minimum purchase ages for tobacco and improved cessation interventions can help reduce disparities and the cost to insurers, especially public costs through Medicaid.
authors.affiliation: Georgetown University, Washington, DC, USA. mkmohlman@gmail.com.
authors.forename: Mary Katherine
authors.initials: MK
authors.lastname: Mohlman
authors.affiliation: Georgetown University, Washington, DC, USA. dl777@georgetown.edu.
authors.forename: David T
authors.initials: DT
authors.lastname: Levy
mesh_terms: D000328:Adult; D017677:Age Distribution; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008423:Maternal Age; D008429:Maternal Welfare; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D012959:Socioeconomic Factors; D013398:Sudden Infant Death / Q000453:epidemiology; D064424:Tobacco Use / Q000009:adverse effects* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Attributable; Disparities; Maternal; Preterm; Smoking