Smoking Still Matters Before, During and After Pregnancy

Maternal, Child and Adolescent Health (MCAH) Division Center for Family Health

August 25, 2015

California Department of Public Health

Photo: MCAH Library

Maternal Tobacco Control Collaboration • In 2012, California Department of Public Health Director

created Inter-Program Collaboration Contest challenge – Partners:

• Maternal, Child and Adolescent Health Division, California Tobacco Control Program, California Smoker’s Helpline, Medi-Cal, Medi-Cal Incentives to Quit Smoking Project, Text4baby/Quit4baby, Environmental Health Investigation Branch

– Key Activities: • Established partnerships • Developed tailored materials and resources with consistent

messaging • Used data to advance program activities and cessation efforts • Integrated tobacco control efforts into direct service programs

California Department of Public Health

Why Smoking Matters?

California Department of Public Health

Life Course Perspective Before Pregnancy • Reduce fertility

and conception • Sensitivity to

nicotine addition greater among younger adults than older.

During Pregnancy (Complicatons) • Placenta previa, placental

abruption, • Premature rupture of

membranes, • Low birth-weight,

premature delivery and stillbirth

• Greater likelihood offspring will also be smokers.

After Pregnancy (impact on children) • Sudden Infant Death

Syndrome (SIDS) • Increased asthma • Bronchitis • Pneumonia • Ear infections • Secondhand

Smoke/Thirdhand Smoke

Better Maternal and Infant Health Outcomes

Maternal and Infant Health Assessment (MIHA) Survey

• MIHA is an annual population-based survey of women with a recent live birth, with data from 1999-2013

• MIHA collects information about smoking at 3 time points: • 3 months before pregnancy • 3rd trimester of pregnancy • After pregnancy

• MIHA is a collaborative effort of: • Maternal, Child and Adolescent Health (MCAH) Program

• California Women, Infants and Children (WIC) Program

• The University of California, San Francisco (UCSF)

• Genetic Disease Screening Program (GDSP)

California Department of Public Health

Smoking during the third trimester of pregnancy PRAMS and MIHA, 1999-2013

Data Source: Maternal and Infant Health Assessment (MIHA) Survey, 1999-2013 and Pregnancy Risk Assessment Survey (PRAMS), 2000-2011. Notes: PRAMS estimates based on 40 PRAMS sites. MIHA data are weighted to represent all women with a live birth in California for a given year.

Smoking before, during, and after pregnancy PRAMS and MIHA, 2011

Data Source: California data - Maternal and Infant Health Assessment (MIHA) Survey, 2011 . Pregnancy Risk Assessment Monitoring Survey, 2011. Notes: MIHA data are weighted to represent all women with a live birth in California in 2011. *No HP 2020 objective exists for smoking after pregnancy.

HP 2020 Objective*

Smoking before, during, and after pregnancy by race MIHA 2012-2013

Data Source: Maternal and Infant Health Assessment (MIHA) Survey, 2012-2013 Notes: MIHA data are weighted to represent all women with a live birth in California.

Smoking before, during, and after pregnancy by prenatal health insurance, MIHA 2012-2013

Data Source: Maternal and Infant Health Assessment (MIHA) Survey, 2012-2013 Notes: MIHA data are weighted to represent all women with a live birth in California for a given year.

White women on Medi-Cal have a high prevalence of smoking during pregnancy (2012-2013)

Data Source: Maternal and Infant Health Assessment (MIHA) Survey, 2012-2013 Notes: MIHA data are weighted to represent all women with a live birth in California for a given year.

Most women quit smoking during pregnancy

Data Source: Maternal and Infant Health Assessment (MIHA) Survey, 2012-2013 Notes: MIHA data are weighted to represent all women with a live birth in California for a given year.

However, one-third of women who quit relapsed

postpartum

• Affordable Care Act requires both Medi-Cal and private insurance to cover comprehensive tobacco cessation benefits for pregnant women, including counseling and medication. 1

• Cessation programs for pregnant women save money • Spending $1 save $3. 2

• Four out 10 women of reproductive age who smoke have not been advised to quit by their health provider 3

• Use the “Ask, Advise and Refer” approach – it takes just 3 minutes!4

Promote Tobacco Cessation Services

California Department of Public Health

1. Jennifer Singleterry, MA, Zach Jump, MA, Elizabeth Lancet, MPH, Stephen Babb, MPH, Allison MacNeil, MPH, Lei Zhang, PhD. (2014). State Medicaid Coverage for Tobacco Cessation 2. Ruger JP, Emmons KM. Economic evaluations of smoking cessation and relapse prevention programs for pregnant women: A systematic review. Value in health 2008;1(2):180-190.

Treatments and Barriers to Coverage — United States, 2008–2014. MMWR., 63, 12 3. Behavioral Risk Facto Surveillance System- California Adult Tobacco Survey, 2013 4. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services.

Public Health Service. May 2008.

Smoking: Before, During and After Pregnancy Fact Sheet

California Department of Public Health

Smoking: Before, During and After Pregnancy Fact Sheet: Data Table

California Department of Public Health

Smoking: Before, During and After Infographic

California Department of Public Health

Still More Work To Do! • Although the prevalence of prenatal smoking is

low in California, smoking among pregnant women is an important public health issue because it’s a preventable health risk factor for adverse birth outcomes. • Women are still smoking before and after

pregnancy.

• As disparities persist, we must continue to work collaboratively.

California Department of Public Health

Additional Resources

• Learn more about MCAH: • www.cdph.ca.gov/MCAH

• To learn more about the Maternal and Infant Health Assessment (MIHA), visit: • www.cdph.ca.gov/MIHA

• Fact Sheet and Infographic : • www.cdph.ca.gov/MCAH/MaternalHealth

• CDC, Smoking and Reproduction • CDC: Smoking and Reproduction

California Department of Public Health

Thank You!

Martha E. Dominguez, MA, MPH

Program Consultant Policy and Program Standards Branch

Phone: (916) 552-8742 martha.dominguez@cdph.ca.gov

Melanie Dove, ScD, MPH Research Specialist

Epidemiology, Assessment and Program Development Branch

Phone: (916) 650-0328 melanie.dove@cdph.ca.gov

California Department of Public Health

California Department of Public Health Maternal, Child and Adolescent Health Division