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Complete Indicator Report of Smoking in the Third Trimester of Pregnancy

Definition

Women who reported smoking during the third trimester of their pregnancies.

Numerator

Number of women reported on Utah Certificates of Live Births as having smoked in the last trimester of their pregnancies.

Denominator

Number of live births to Utah residents regardless of where they occurred.

Data Interpretation Issues

Cigarette data is obtained through self-report by women through either responses to survey questions within four months of a live birth (PRAMS data), or through Certificates of Live Births (Utah Vital Records data). Either of these processes may result in recall bias. The percent of women who report smoking in the third trimester of pregnancy is higher on the PRAMS surveys (4.0% in 2011 - the most recent data available) which are submitted anonymously, than rates from certificates of live births (3.4% in 2011) on which the mothers' names are included. Due to the stigma attached to smoking during pregnancy, women may be less than forthcoming regarding their use of tobacco resulting in under-reporting of actual cigarette usage.

Why Is This Important?

2012 Utah Vital Records data drawn from Certificates of Live Births indicate that 3.4% of women smoked during the last trimester of their pregnancies. According to the 2010 Surgeon General's Report, "How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Diseases," cigarette smoking during pregnancy increases the risk for: low birth weight, neurologic deficits in offspring, increased maternal blood pressure and heart rate, preterm birth, premature rupture of membranes, placental abruption, placenta previa, miscarriage, stillbirth, neonatal mortality, cleft lip/palate, fetal growth restriction/small for gestational age, and Sudden Infant Death Syndrome (SIDS). Additionally, women who smoke are less likely to initiate and continue breastfeeding their infants.

Some unfavorable pregnancy outcomes may be reduced or eliminated through smoking cessation, especially if cessation occurs early in pregnancy. This is true for birth weight which decreases as the number of cigarettes smoked increases; however, smoking cessation by the third trimester of pregnancy can eliminate much of the fetal weight reduction risk incurred through maternal smoking. Maternal smoking may also lead to low birth weight (LBW) through complications requiring premature delivery such as preterm, premature rupture of membranes, placental abruption, or placenta previa. It has been estimated that the occurrence of LBW could be reduced by as much as 20% and fetal growth restriction by 30% if all women were nonsmokers during pregnancy.

Other Objectives

There is no Healthy People 2020 Objective for third trimester smoking. However, there is a more general 2020 Objective to increase abstinence from cigarette smoking among pregnant women, with a goal of 98.6%.

How Are We Doing?

According to Utah Vital Records, during 2012, 3.4% or 1,732 Utah women experiencing a live birth reported smoking during the third trimester of pregnancy. This figure represents a very slight increase from 3.3% in 2011. From 2000 through 2012, the highest percentage of third trimester smoking occurred in 2001 with 7.7% of women experiencing a live birth reporting smoking in the third trimester of pregnancy.

How Do We Compare With U.S.?

There are currently no published national data on smoking in the third trimester of pregnancy.

What Is Being Done?

The American Congress of Obstetricians and Gynecologists recommends that pregnant smokers be assessed for smoking activity and readiness to quit and provided resources to assist in cessation at each prenatal visit.

In Utah, all local health departments screen pregnant clients for smoking and provide resources and referrals to promote cessation.

The Utah Department of Health's Medicaid Program and Department of Workforce Services workers screen all pregnant applicants for tobacco use at the time of enrollment. Smokers are provided cessation information and followed-up every six weeks throughout their pregnancies.

Medicaid clients tend to have higher smoking rates than average, so the Tobacco Prevention and Control Program (TPCP) partners with Medicaid to offer quitting services to their clients. The program offers services through the Utah Tobacco Quit Line, and includes coverage of tobacco cessation medications and additional help for pregnant women.

Additionally, through a grant from the TPCP, participating Association for Utah Community Health (AUCH) community health centers offer Zyban and Chantix (smoking cessation medications) free of charge for their uninsured clients. To be eligible for these services, the client must be uninsured, a tobacco user, and an established client with a primary care provider at a participating community health center.

The Utah QuitNet (http://www.utah.quitnet.com) is a state-of-the-art quit smoking support program, which combines personalized information with peer and expert support. The site tracks each person's progress and makes suggestions about next steps. Additionally, QuitNet members have the options of receiving daily "Quit Tips" from the QuitNet via email.

Additional information on smoking cessation, resources, and helpful website links can be found online at the March of Dimes website (www.marchofdimes.com) by clicking on "pregnancy" and searching the topic "smoking."

Available Services

To receive more information about Tobacco Prevention and Control Programs in Utah, call the Tobacco Free Resource Line at 1-877-220-3466.

For information on quitting smoking, call the Utah Tobacco Quit Line at 1-800-QUIT-NOW or visit Utah's online tobacco cessation support program at: utahquitnet.com.



Related Indicators

Relevant Population Characteristics

According to 2012 Vital Records, smoking during the third trimester of pregnancy is the highest among women 15-19 years of age. According to 2010 PRAMS data, smoking during the third trimester is more prevalent among women who have only a high school education or less; are unmarried; who have lower income; and have no insurance or are on Medicaid before and/or during pregnancy.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

According to 2011 PRAMS data, of the women who smoked in the three months before pregnancy, 74.3% reported their health care provider discussed how smoking could affect their baby. Among women who did not smoke, these discussions were reported less frequently with only 43.7% indicating that their doctor discussed smoking.

Related Health Care System Factors Indicators:


Risk Factors

2011 PRAMS data has shown that women who have lower income, had a lower education level (high school or less), are 19 years old or younger, are unmarried, and have no insurance or are on Medicaid were more likely to smoke during their last three months of pregnancy.

Related Risk Factors Indicators:


Health Status Outcomes

According to 2011 Utah PRAMS data, women who smoked during the last three months of pregnancy had statistically significant higher percentages of low birth weight infants when compared with non-smokers (14.0% vs 5.6%). While not statistically significant, smokers also had a higher percentage of preterm births than non-smokers (11.4% vs 7.6%).

Related Health Status Outcomes Indicators:




Graphical Data Views

Women Reporting Smoking in the Third Trimester of Pregnancy, Utah, 2000-2012

::chart - missing::
confidence limits

Year Percent Reporting Third Trimester Smoking Lower Limit Upper Limit
Record Count: 13
2000 7.3% 5.7% 9.3%
2001 7.7% 6.4% 9.3%
2002 6.8% 5.2% 8.7%
2003 3.9% 2.9% 5.2%
2004 4.7% 4.5% 4.9%
2005 4.3% 4.2% 4.5%
2006 4.3% 4.2% 4.5%
2007 4.2% 4.0% 4.3%
2008 3.9% 3.7% 4.1%
2009 3.6% 3.4% 3.7%
2010 3.2% 3.0% 3.3%
2011 3.3% 3.1% 3.4%
2012 3.4% 3.2% 3.5%

Data Sources

Utah Birth Certificate Database, Office of Vital Records and Statistics, Utah Department of Health.



Percentage of Utah Women Who Smoked in the Third Trimester of Pregnancy by Age, 2010-2012

::chart - missing::
confidence limits

Age Group Percentage Reporting Third Trimester Smoking Lower Limit Upper Limit
Record Count: 6
15-19 5.7% 5.1% 6.2%
20-24 5.0% 4.7% 5.2%
25-29 2.9% 2.7% 3.0%
30-34 2.4% 2.2% 2.5%
35-39 1.9% 1.7% 2.2%
40-44 2.2% 1.7% 2.8%

Data Notes

Due to the relatively small number of women reporting smoking in the third trimester of pregnancy, three consecutive years of data are grouped together to provide sufficient data for analysis.

Data Sources

Utah Birth Certificate Database, Office of Vital Records and Statistics, Utah Department of Health.



Smoking in the Third Trimester of Pregnancy by Local Health District, Utah, 2010-2012

::chart - missing::
confidence limits

Local Health District Percentage of Women Lower Limit Upper Limit
Record Count: 13
Bear River 2.7% 2.4% 3.1%
Central 5.6% 4.8% 6.4%
Davis County 2.2% 2.0% 2.4%
Salt Lake County 3.5% 3.3% 3.7%
Southeastern 9.7% 8.5% 10.9%
Southwest 3.8% 3.4% 4.1%
Summit 1.6% 0.9% 2.3%
Tooele 6.4% 5.5% 7.3%
TriCounty 9.6% 8.5% 10.7%
Utah County 1.3% 1.2% 1.4%
Wasatch 3.4% 2.3% 4.4%
Weber-Morgan 5.3% 4.9% 5.7%
State 3.4% 3.2% 3.5%

Data Notes

Due to the relatively small number of women reporting smoking in the third trimester of pregnancy, three consecutive years of data are group together to provide sufficient data for analysis.

Data Sources

Utah Birth Certificate Database, Office of Vital Records and Statistics, Utah Department of Health.


References and Community Resources

CDC's Tobacco Use and Pregnancy: http://www.cdc.gov/reproductivehealth/TobaccoUsePregnancy/index.htm

The Surgeon General's Report 2010: A Report of the Surgeon General: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, Executive Summary:
http://www.surgeongeneral.gov/library/reports/tobaccosmoke/index.html

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

Page Content Updated On 11/18/2013, Published on 12/04/2013
The information provided above is from the Utah Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.utah.gov). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Fri, 31 October 2014 0:08:44 from Utah Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.utah.gov".

Content updated: Wed, 4 Dec 2013 17:17:00 MST