BACKGROUND: Smoking among women of reproductive age (WRA) is a core preconception health indicator of the Centers for Disease Control and Prevention (CDC). Improving the health of WRA is critical as 45% of United States (US) pregnancies in 2011 were unintended. Through participation in the Collaborative Improvement and Innovation Network to Prevent Infant Mortality (IM CoIIN), Wyoming is pursuing strategies to reduce smoking among WRA.
METHODS: This analysis used the publicly available Behavioral Risk Factor Surveillance data from 2011, 2013, and 2015 to evaluate smoking prevalence among WRA (15-44 years) in Wyoming, HRSA Region 8 (Region 8), and the US. Three variables of interest were evaluated: current smoker, cessation, and quit attempt in the last year. Prevalence of the three outcomes was calculated by year, geographic region, age, race/ethnicity, education, and marital status. Wald chi-square tests compared the rates. Finally, linear regression evaluated change over time in each outcome of interest. Crude estimates and 95% confidence intervals were calculated. All analysis used SAS Callable SUDAAN version 11.0.1.
RESULTS: In the combined years of 2011, 2013, and 2015, 21.9% of Wyoming WRA reported smoking, significantly higher (p<0.001) than the smoking prevalence in Region 8 (16.2%) or the US (17.2%). There was a similar cessation rate among WRA in Wyoming (40.5%) and the US (42.4%). In Wyoming, 42.3% of current WRA smokers attempted to quit in the previous year, similar to the US and Region 8. A statistically significant decrease in smoking was observed in the US and Region 8 over the study time period. The Wyoming decrease was not significant. In Wyoming, the smoking rate was six fold higher among those who did not complete high school compared with those that completed college, similar to Region 8 and the US. Significant differences in smoking rates also exist by race in the US and by age in the US and Region 8. Stark differences exist in cessation rates by all demographics calculated except race in Region 8 and Wyoming.
CONCLUSIONS: Smoking among WRA, like smoking among the general population, is declining. Smoking and cessation rates among WRA vary by geographic location and are higher in Wyoming. Large disparities also exist in smoking and cessation rates by socioeconomic and demographic characteristics. Public health must use a mix of proven and novel approaches to sustain and accelerate the decline in smoking among WRA.