smoking still matters before, during and after pregnancy · •placenta previa, placental...
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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
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