BACKGROUND:
Smoking during pregnancy is linked to poor birth outcomes including preterm birth, low birthweight, miscarriage, and increased risk of sudden infant death syndrome. In order to assess the geographic variation of smoking during pregnancy across all 50 states, we calculated prevalence estimates using the Behavioral Risk Factor Surveillance System (BRFSS) by state and by subpopulation groups (age, race/ethnicity, education, income, and urbanicity).
METHODS:
BRFSS data from 2011-2014 were analyzed using Stata v14.1 to account for the complex survey design. National and state estimates were calculated using the specified survey weights and represent the non-institutionalized adult population. Smoking during pregnancy was defined as the percentage of pregnant women aged 18-44 who smoked at least 100 cigarettes in their lifetime and currently smoke. Responses of “refused”, “don’t know,” or “not sure” were excluded from the analysis, but are reflected in standard error and confidence interval estimates. Estimates were also stratified by age, race/ethnicity, urbanicity, education, and income groups.
RESULTS: Smoking prevalence during pregnancy ranged from a low of 1.4% of women aged 18-44 years in Connecticut to a high of 24.2% in West Virginia. Nationally, an estimated 10.5% of pregnant women aged 18-44 smoke. Among pregnant women, smoking prevalence was highest among those aged 18-24 years (15.2%, 95% CI: 13.0%-17.4%), American Indian/Alaska Native women (26.1%, 95% CI: 14.6%-37.5%), those with less than a high school education (17.7%, 95% CI: 13.0%-22.4%), and those with incomes less than $25,000 (19.2%, 95% CI: 16.2%-22.2%). Among pregnant women, smoking prevalence was lowest among those aged 35-44 years (7.6%, 95% CI: 5.9%-9.4%), Asian women (1.4%, 95% CI: 0%-2.7%), college graduates (1.4%, 95% CI: 1.0%-1.9%), and those with incomes greater than $75,000 (1.3%, 95% CI: 0.8%-1.7%).
CONCLUSIONS:
Based on 2011-2014 BRFSS data, 1 in 10 pregnant women aged 18-44 years smoke and the prevalence varies widely by state, age, race/ethnicity, education, and income. Smoking prevalence among pregnant women in West Virginia is 17.3 times higher than in Connecticut. Identifying pregnant women who smoke early in pregnancy and offering evidence-based programs to support smoking cessation in pregnancy could reduce poor birth outcomes.