Sociodemographic, insurance, and risk profiles of maternal smokers post the 1990s: How can we reach them?

Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Nicotine & Tobacco Research (Impact Factor: 3.3). 07/2008; 10(7):1121-9. DOI: 10.1080/14622200802123278
Source: PubMed


Declines in prenatal smoking rates have changed the composition of maternal smokers while public policy during the 1990s has likely made it more difficult to reach them. Medicaid expansions during the 1980s/early 1990s insured more women some time during pregnancy, but the 1996 welfare reform unexpectedly reduced enrollment in Medicaid by eligible pregnant women; overall, insurance coverage has declined since 2000. As the public sector struggles with fewer resources, it is important to understand the sociodemographic characteristics of prenatal smokers, their patterns of care, and nonsmoking risk behaviors. Targeting scarce dollars to certain settings or sub-populations can strengthen the infrastructure for tobacco policy change. We provide more current information on maternal smokers in 2002 based on the Pregnancy Risk Assessment Monitoring System (PRAMS) for 21 states. Data on urban/rural location, insurance coverage, access patterns, and nonsmoking risk behaviors (e.g., abuse) among low-income (<16,000) and other maternal smokers are included. Low-income maternal smokers are the working poor living in predominately urban areas with fewer health care resources than low-income nonsmokers. Over 50% of low-income maternal smokers are uninsured pre-pregnancy and use a clinic as their usual source of care. Regardless of income, smokers exhibit rates of nonsmoking risks that are two to three times those of nonsmokers and high rates of unintended pregnancy (68%) of low-income smokers. These characteristics likely call for a bundle of social support services beyond cessation for smokers to quit and remain smoke-free postpartum.

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    • "Despite these adverse effects, in 2005 around 13 percent of women self-report smoking during pregnancy based on birth certificates or PRAMS data (Tong et al 2009). Although the national data indicate an almost 45 percent drop from the 18.4 percent reported in 1990, at least half of mothers who smoke pre-pregnancy continue to smoke postpartum (Wakschlag, et al., 2003; Adams et al. 2008). With little change in postpartum relapse rates occurring (Colman et al. 2003), permanent changes in maternal smoking will require additional tobacco control efforts. "
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