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Maternal and Child Health Journal

Erschienen in:

17.03.2016

The Effect of Local Smokefree Regulations on Birth Outcomes and Prenatal Smoking

verfasst von: Karla S. Bartholomew, Rahi Abouk

Erschienen in: Maternal and Child Health Journal | Ausgabe 7/2016

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Abstract

Objectives We assessed the impact of varying levels of smokefree regulations on birth outcomes and prenatal smoking. Methods We exploited variations in timing and regulation restrictiveness of West Virginia’s county smokefree regulations to assess their impact on birthweight, gestational age, low birthweight, very low birthweight, preterm birth, and prenatal smoking. We conducted regression analysis using state Vital Statistics individual-level data for singletons born to West Virginia residents between 1995–2010 (N = 293,715). Results Only more comprehensive smokefree regulations were associated with statistically significant favorable effects on birth outcomes in the full sample: Comprehensive (workplace/restaurant/bar ban) demonstrated increased birthweight (29 grams, p < 0.05) and gestational age (1.64 days, p < 0.01), as well as reductions in very low birthweight (−0.4 %, p < 0.05) and preterm birth (−1.5 %, p < 0.01); Restrictive (workplace/restaurant ban) demonstrated a small decrease in very low birthweight (−0.2 %, p < 0.05). Among less restrictive regulations: Moderate (workplace ban) was associated with a 23 g (p < 0.01) decrease in birthweight; Limited (partial ban) had no effect. Comprehensive’s improvements extended to most maternal groups, and were broadest among mothers 21+ years, non-smokers, and unmarried mothers. Prenatal smoking declined slightly (−1.7 %, p < 0.01) only among married women with Comprehensive. Conclusions Regulation restrictiveness is a determining factor in the impact of smokefree regulations on birth outcomes, with comprehensive smokefree regulations showing promise in improving birth outcomes. Favorable effects on birth outcomes appear to stem from reduced secondhand smoke exposure rather than reduced prenatal smoking prevalence. This study is limited by an inability to measure secondhand smoke exposure and the paucity of data on policy implementation and enforcement.

Note, however, research indicates that comprehensive smokefree measures are more effective in reducing air particulate matter (i.e., SHS) than are partial smokefree measures. See, Erazo et al. [16], Fernandez et al. [18], Huss et al. [22] and Ward [43].

Defined here as no state-level smoking restriction in any of the following three venues: private workplaces, restaurants, or bars. These states include: Alabama, Kentucky, Mississippi, South Carolina, Texas, West Virginia, and Wyoming.

While the majority of local Boards of Health govern a single county, several Boards of Heath govern combined municipal-county units with a very few Boards of Health governing multiple counties.

These actions have been upheld by the West Virginia Supreme Court (Foundation for Independent Living, Inc. v. Cabell-Huntington Board of Health. (2003). 214 W.Va. 818, 519 S.E.2d. 744).

This includes both in-state and out-of-state births to WV residents. WV borders five states (Ohio, Pennsylvania, Maryland, Virginia, and Kentucky) making out-of-state births more routine than in most states.

Information on smoking regulations was obtained through an online search of each county’s regulations, and supplemented with historic data provided by the Smoke-Free Initiative of WV, a division of the West Virginia Department of Health and Human Resources.

West Virginia employment rates for females, 16–54 years (2002): 16–19 years = 33 %, 20–24 years = 54.5 %, 25–34 years = 67.3 %, 35–44 years = 68.1 %, 45–54 years = 63.9 %. U.S. Department of Labor, Bureau of Labor Statistics (--). Employment Status of the Civilian Noninstitutionalized Population by Sex, Race, Hispanic Origin, and Detailed Age, 2002 Annual Averages. http://www.bls.gov/lau/Table12full02.pdf. Additionally, high school enrollment is estimated at 86 % for 15–18 year-olds (96 % in 9th grade declining each year to 79 % in 12th grade; graduation rate is 74 %); while post-secondary enrollment is estimated at 44 % the Fall after high-school graduation, with a 75 % first-year persistence rate and a 16 % graduation rate within 6 years. Estimated from data available from Southern Regional Education Board (http://www.sreb.org) and National Center for Education Statistics (http://nces.ed.gov).

The legal age for purchasing alcohol in West Virginia has been 21 years since 1986; private clubs/bars, however, may choose to allow entrance to individuals 18 years of age and older. Alcohol Beverage Control Commissioner, Series 2–Private Club Licensing (§175-2-4.12).

Data obtained from the U.S. Environmental Protection Agency: http://www.epa.gov/airquality/airdata. Data on other pollutants are not available.

This has proven effective in other contexts for capturing confounding variation over longer periods of time. See, Barreca [5], Raphael and Winter-Ebmer [36] and Wolfers [45].

U.S. comparison data were obtained from the Centers for Disease Control and Prevention (CDC) “Natality Files” and “Linked Birth/Infant Death System” on CDC WONDER. http://wonder.cdc.gov. Note, however, these datasets did not provide information on Live Birth Order prior to 2003. Additionally, birth certificates (from which the CDC data were derived) changed tobacco use questions in 2003, complicating comparisons of data prior to versus after 2003.

Note the smoking prevalence of 32 % among mothers <18 years, despite the legal age of 18 for purchasing tobacco in West Virginia.

There could also exist variations in biological response to SHS based upon maternal characteristics, but a survey of the existing literature did not support this.

Note, smoking prevalence data is based upon self-reported smoking status among women at time of delivery. While self-reports carry the risk of inaccuracies, there is no indication that these errors would be systematic across time or place.

Some research suggests that a decrease in quantity of cigarettes smoked follows implementation of a smokefree regulation, even when the prevalence of smoking does not decrease [31]. Smokefree regulations could, therefore, potentially reduce prenatal smoking quantity without any apparent change in smoking prevalence. Our data, however, would not capture any change in quantity, frequency, or duration of prenatal smoking.

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Titel: The Effect of Local Smokefree Regulations on Birth Outcomes and Prenatal Smoking
verfasst von: Karla S. Bartholomew
Rahi Abouk
Publikationsdatum: 17.03.2016
Verlag: Springer US
Erschienen in: Maternal and Child Health Journal / Ausgabe 7/2016
Print ISSN: 1092-7875
Elektronische ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-016-1952-x

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The Effect of Local Smokefree Regulations on Birth Outcomes and Prenatal Smoking

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