DefinitionWomen who reported smoking during the third trimester of their pregnancies.
NumeratorNumber of women reported on Utah Certificates of Live Births as having smoked in the last trimester of their pregnancies.
DenominatorNumber of live births to Utah residents regardless of where they occurred.
Data Interpretation IssuesCigarette 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 percentage of women who report smoking in the third trimester of pregnancy is higher on the PRAMS surveys (3.5% in 2016 - the most recent data available) which are submitted anonymously, than rates from certificates of live births (2.3% in 2016) 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?2017 Utah Vital Records data drawn from Certificates of Live Births indicate that 2.5% of women smoked during the last trimester of their pregnancies.
Smoking before pregnancy can make it harder for women to get pregnant. During pregnancy, women who smoke cigarettes have a higher risk of delivering their infant too early and with a low birth weight, making it more likely their infant will be sick and have to stay in the hospital longer. These infants also have a higher risk of having some kinds of birth defects such as a cleft lip and palate. Infants whose mothers smoked during pregnancy or were exposed to second hand smoke after delivery have a higher risk of sudden infant death syndrome (SIDS). There is no safe level of tobacco use or exposure for women and their infants. (50 Years of Progress: A Report of the Surgeon General: [https://www.surgeongeneral.gov/library/reports/50-years-of-progress/50-years-of-progress-by-section.html])
Other ObjectivesThere is no Healthy People 2020 Objective for third trimester smoking. However, there is a more general 2020 Objective (MICH-11.3) to increase abstinence from cigarette smoking among pregnant women, with a target of 98.6%. There is another HP2020 Objective (TU-6) to increase smoking cessation during pregnancy, with a target of 30.0%. Additionally, objective (MICH-18) calls for a reduction of postpartum relapse of smoking among women who quit smoking during pregnancy, with a target of 38.2%.
How Are We Doing?According to Utah Vital Records data, the percentage of Utah women smoking in the third trimester increased from 2.3% in 2016 to 2.5% in 2017. From 2002 through 2017, the highest percentage of third trimester smoking occurred in 2002 with 6.8% of women experiencing a live birth reporting smoking in the third trimester of pregnancy.
How Do We Compare With the U.S.?According to PRAMS data, the overall percentage of women smoking in the third trimester in 2015 (most recently available national data) was 8.8 for the 34 participating PRAMS sites compared to 4.0% in Utah.
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 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.
To inform Utahns about tobacco cessation strategies and quit services, the Tobacco Prevention and Control Program (TPCP) at the Utah Department of Health maintains a comprehensive quit website - [http://waytoquit.org]. Utah's anti-tobacco marketing campaign encourages Utah smokers to make quit attempts and informs about [http://waytoquit.org waytoquit.org] and other quit programs.
TPCP is also addressing the use of e-cigarrettes and hookah. Regarding the use of e-cigarettes among high school seniors and 18- to 24-year-olds, the TPCP states:^1^
*In 2017, 32.1% of high school seniors reported that they had tried e-cigarettes and 15.5% were current users.[[br]]
*In 2016, for ages 18 to 24, the percentage of e-cigarette users was 12.1%.[[br]]
Local health departments (LHDs) promote quit services at the community level and offer local programs to assist pregnant and teen smokers with quitting. In addition, the TPCP partners with healthcare providers and healthcare organizations such as the Association for Utah Community Health (AUCH) and Medicaid to improve access to quit services, counseling, and medications for populations with higher tobacco use rates.
Beginning in April of 2016, PRAMS began asking about the use of e-cigarettes and hookah, before and during pregnancy. These questions are in addition to questions regarding cigarette smoking. In 2016, the percentage of women reporting use of e-cigarettes during the third trimester was 2.1.
Additional information on smoking cessation, resources, and helpful website links can be found online at the March of Dimes website [http://www.marchofdimes.com] by clicking on ''Health Topics --> Pregnancy --> Is it safe? --> smoking during pregnancy.''[[br]]
''1. Tobacco Prevention and Control in Utah, Seventeenth Annual Report, December 2017''