More pregnant mothers smoking, rates particularly high in rural counties

By BRIDGET BUSH

Capital News Service

LANSING– Limited educational resources for smoking prevention and cessation, combined with limitless high-risk addictive substances caused a spurt in women who smoke during pregnancy, policy experts and educators say.

Babies of smokers are at an increased risk of malnourishment, preterm birth, asthma, childhood obesity and sudden death, according to the American College of Obstetricians and Gynecologists.

“More mothers smoking during pregnancy means more babies are being born with lifelong complications,” said Alicia Guevara-Warren, Kids Count project director at the Michigan League for Public Policy.

The number of births to women who smoked while pregnant skyrocketed 18 percent from 2008 to 2014, according to a recent report by the league. That means that 21.4 percent of all live births in Michigan are to mothers who smoked during pregnancy, the 27th-highest rate in the country.

Many counties with the highest rates of mothers smoking while pregnant had the highest birth rates by mothers with no diploma or GED, according to the league’s 2016 Right Start Report on Maternal and Child Health. Guevara-Warren linked smoking and low education levels.

The smoking rates are particularly high among pregnant women in rural northern Michigan counties. Among the highest: Crawford — 47.7 percent, Roscommon — 46.9 percent, Baraga — 46.4 percent, Luce — 45.2, Alcona — 44.9 percent, Alpena — 44.7 percent, Schoolcraft — 42.9 percent, Clare — 41.9 percent, Kalkaska — 41.6 percent, Chippewa — 39.9 percent and Lake — 39.7 percent, the report said.  

Rate of births by mothers who smoke during pregnancy by county

Rate of births by mothers who smoke during pregnancy by county

Part of the reason for the increase is the underfunding of smoking cessation programs and youth education programs, Guevara-Warren said.

State spending on smoking prevention and cessation is down 34 percent since 2008, the report said. While Michigan spent $5.73 million on these initiatives in 2008, today it budgets only $3.78 million for the upcoming 2017 fiscal year. Programs targeted at pregnant mothers receive an average of $10,500 from that sum, Guevara-Warren said.

County health departments that offer counseling and collaborate with the 24/7, toll-free QuitLine number for smokers seeking immediate help are also underfunding these programs.

While more than one-fifth of all births in 2014 were to mothers who smoked while pregnant, only 2 percent of those women participated in a class or support group to help them stop smoking during pregnancy, the report said.

“Seeking care is more difficult for less-populated areas because of transportation and limited availability of services,” Guevara-Warren said.

One-on-one conversations between physicians and pregnant mothers can be the most influential in stopping smoking, said Maria Lapinski, a professor in the Department of Communication at Michigan State University.

Smoking during pregnancy exposes the baby to harmful chemicals, including tar, nicotine and carbon monoxide, according to research by the American College of Obstetricians and Gynecologists. Nicotine and carbon monoxide cause blood vessels to constrict, allowing less oxygen and nutrients to reach the baby. Smoking may increase preterm births because it causes the placenta to attach to the uterus in a different way,the group said.

Infants born to mothers who smoked during pregnancy tend to be smaller and more likely to have asthma, colic and childhood obesity, according to the group. They also have an increased risk of dying from sudden infant death syndrome (SIDS).

Another reason behind the increase in smoking mothers may be that health care providers are targeting the wrong people. The League for Public Policy’ reported that while the rate of smoking is highest among white mothers at 23.5 percent, health care providers are less likely to discuss the dangers of smoking during pregnancy with white mothers (71.5 percent discussed) than black mothers (85 percent discussed).

These numbers call for a reevaluation of potential biases within the health care profession, said Guevara-Warren.

Health care providers should also increase the number of physicians with cultural competency training, said Guevara-Warren. Michigan has increasing populations of Hispanic children. Seventy counties experienced an increase in the number of young African-American children under 6, and 55 counties had an increase in young American Indian children, the league report said.

It’s a national problem.

The U.S. Department of Health and Human Services reported last February that 21 of 31 states surveyed experienced a significant increase in the number of mothers smoking at any time during pregnancy from 2003 to 2014, Guevara-Warren said.

Budget cuts aren’t only to blame for this uptick in mothers smoking during pregnancy. Rather, the ever-evolving and countless nicotine-based options such as hookahs and electronic cigarettes have created more avenues for smoking than ever before, addiction experts said.

Schools offer anti-addiction education.

“Young people face more high-risk behavior activities than ever before — everyday there’s a new addictive substance,” said Richard Mahan, director of communications for Drug Abuse Resistance Education USA based in California. “That’s why our program doesn’t focus on individual substances, but on building decision-making skills.”

With the prevalence of tobacco, prescription drugs and legalized marijuana, educators and physicians are fighting a lethal assumption among youth who think because something is legal means it is not dangerous, Mahan said. “Kids have a false sense of comfort, which leads to a tendency to rationalize unhealthy behaviors.”

When a substance is considered legal, the popular perception is less likely to be that consumption of that product is harmful or life-threatening, he said.

Last Augus,t the federal government began regulating e-cigarette and hookah sales,  Guevara-Warren said. It now prohibits minors under 18 from purchasing these items.

This action is important to preventing smoking during pregnancy because 90 percent of adult smokers started at or before age 18, she said.

For those who smoke before pregnancy, women’s top health care physicians have identified some best practices for obstetric practice, particularly among underserved women, said Jamila Vernon, manager of media relations and communications for the American College of Obstetricians and Gynecologists.

That organization has identified smoking as one of the most important modifiable causes of poor pregnancy outcomes in the United States. It points out that smoking during pregnancy is associated with maternal, fetal and infant complications and mortality.

The group recommends Five A’s for smoking cessation:

  • Ask the patient about smoking status
  • Advise the patient to stop by explaining the risks
  • Assess the patient’s willingness to quit
  • Assist the patient with pregnancy-specific self-help cessation materials that explain strategies as a quitting buddy or using a quit line telephone number
  • Arrange follow-up visits to track progress towards quitting

“Any communication intervention starts with the community at risk,” according to Lapinski, who studies the impact of messages and social-psychological factors on health and environmental risk behaviors. “It is simply a matter of prioritizing a problem and identifying the resources to tackle.”

But it’s hard to ‘”win” in a crowded information environment, Lapinski said.

“Tobacco companies spend billions of dollars — $9.5 billion in 2013, for example — each year marketing their products,” Lapinski said. “To contextualize that, the Centers for Disease Control and Prevention only has a fraction of that ($748 million) to address the outcomes of smoking for the whole country.”

In Michigan alone, the ratio of spending by tobacco companies to market their products to state spending on tobacco prevention is 189.7 to 1, according to the league’s report. When you add in the addictive nature of cigarettes, Lapinski sees the deck to be “fully stacked against people trying to reduce or prevent smoking during pregnancy.”