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In New Hampshire, smoking prevalence is estimated to be 16.2% i reflecting a steady decline for the past 20 years. Maternal smoking (smoking during pregnancy) is an area where New Hampshire can do better.

Why is smoking during pregnancy bad for mom and baby? Maternal smoking is associated with a 27% increase in the risk of preterm delivery (having a birth before the baby is fully developed); nicotine has adverse health effects on both the mother and baby during pregnancy, contributing to multiple adverse outcomes such as: premature birth (being born too early), low birth weight, stillbirth, orofacial clefts (cleft palate and cleft lip), ectopic pregnancy, sudden infant death syndrome (SIDS), and ongoing undesirable effects on lung function across childhood ii.

  • Smoking makes it harder for a woman to get pregnant
  • Women who smoke during pregnancy are more likely than other women to have a miscarriage
  • Smoking during pregnancy can:
    • cause problems with the placenta – the source of the baby's food and oxygen during pregnancy. For example, the placenta can separate from the womb too early, causing bleeding, which is dangerous to the mother and baby
    • cause a baby to be born too early or to have low birth weight – making it more likely the baby will be sick and have to stay in the hospital longer. A few babies may even die
    • Babies born to women who smoke are more likely to have certain birth defects, like a cleft lip or cleft palate iii.

Prevent clefts caused by smoking infographic

Who are the women who are smoking during pregnancy and why? Quitting smoking is difficult; nicotine is a highly addictive drug for which patterns of use and the development of dependence are strongly influenced by factors such as availability, price, social pressures, and regulations. Therefore, strong barriers to women quitting during pregnancy are addiction, heightened stress, a partner or household where there is smoking, fear of withdrawal, and mis-education or misinformation about the health risks to the baby. Maternal smoking and smoking in the general population is higher in populations with lower educational and economic attainment. Among lower socioeconomic NH women who gave birth from 2012-2014, 33.5% reported smoking during pregnancy iv. This number is much higher than in the general population (16.2%).

Certain areas of the State have noticeably higher maternal smoking rates: Coos (27.8%) and Sullivan (25.3%) Counties v stand out. When you look at New Hampshire's County Health Rankings vi (countyhealthrankings.org), Coos and Sullivan counties (by Health Outcome and Health Factors) are also ranked as having poorer health.

The County Health Rankings illustrate what we know when it comes to what is making people sick or healthy. The Rankings help counties understand what influences how healthy residents are and how long they will live. They also look at a variety of measures that affect the future health of communities, such as high school graduation rates, access to healthy foods, rates of smoking, obesity, and teen births.

Rankings, however, do not always tell the whole story. When you look at Hillsborough County it tends to fall ahead or in the middle of the pack for health determinants as well as when you look at maternal smoking rates (12.6%) for the county. However, when you begin to look deeper and separate the data for NH's two largest cities, you can see that not all populations are faring the same – maternal smoking in Manchester is 17.6% and Nashua is 12.1%. Without the two micro cities, Hillsborough's rate drops to 8.6%. Manchester's rate is more than double Hillsborough's rate and the rate of the "healthiest" county, Rockingham County (7.3%), as well.

What are we doing about it? The health of mothers and children, including reducing maternal smoking, was identified as a priority in the New Hampshire State Health Improvement Plan (SHIP) vii. The SHIP identifies 10 priority areas for improvement with measurable objectives and targets for health outcomes; areas for needed attention in public health capacity; and, recommendations for evidence-based interventions and actions. It includes time-framed targets for each priority. The SHIP goal is to reduce preterm births in NH by 8%, (from 9.9% (2009) to 9.1% (2015)) and by a total of 10% by 2020 (to 8.9%).

We can do more: The preterm birth rate for NH lower socioeconomic women who smoke during pregnancy is 11.4%, significantly higher than the general population and NH lower socioeconomic women who did not smoke during pregnancy (7.8%) viii. Low birth weight is also an adverse outcome from maternal smoking. The rate of lower socioeconomic women who smoked during pregnancy who had a baby with a low birth weight (12.0%) was twice as high as women who did not smoke during pregnancy (6.1%) ix.

This population of women who are struggling financially and smoking during pregnancy is hard to reach, they may not have consistent primary or prenatal care, may have unstable living conditions, poor access to food and transportation, and limited social support. The NH Division of Public Health Services (DPHS) has made access to care and assistance with smoking cessation a priority for these women. The NH DPHS currently offers:

  • The NH Tobacco Helpline (1-800-QUIT-NOW) x, which prioritizes pregnant and postpartum clients and offers no-cost assistance for quitting tobacco use
  • NH Women, Infants and Children Nutrition Program (WIC) xi, provides nutrition education and nutritious foods to help keep pregnant women, new mothers, infants and preschool children healthy and strong
  • NH Maternal and Child Health (MCH) Section xii, supports a broad array of programs in order to improve the availability of and access to high quality preventive and primary health care for all children and to reproductive health care for all women and their partners regardless of their ability to pay
  • Culturally competent perinatal care through community health centers (through partner support and funding)
  • Centering Pregnancy best practice model of group prenatal care to promote optimal birth outcomes promotion
  • Support of efforts to reduce non-medically indicated early-term deliveries prior to 39-weeks gestation
  • Use of evidence-based practice to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs
  • Increased awareness of preterm birth outcomes with the text4baby and Healthy Babies are Worth the Wait programs
  • Technical assistance to decrease non-med¬ically indicated early and preterm deliveries

i 2013 New Hampshire Behavioral Risk Surveillance System.
ii U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014.
iii http://www.cdc.gov/reproductivehealth/tobaccousepregnancy/. [accessed April 2, 2015]
iv Analysis of 2012-2014 NH Vital Records by New Hampshire Division of Public Health Services, Maternal and Child Health Section, April 2015.
v Analysis of 2012-2014 NH Vital Records by New Hampshire Division of Public Health Services, Maternal and Child Health Section, April 2015.
vi http://www.countyhealthrankings.org/app/new-hampshire/2015/overview. [accessed April 2, 2015]
vii https://www.dhhs.nh.gov/dphs/documents/nhship2013-2020.pdf Adobe Acrobat Reader Symbol. [accessed April 2, 2015]
viii Analysis of 2012-2014 NH Vital Records by New Hampshire Division of Public Health Services, Maternal and Child Health Section, April 2015.
ix Analysis of 2012-2014 NH Vital Records by New Hampshire Division of Public Health Services, Maternal and Child Health Section, April 2015.
x QuitNowNH.org
xi https://www.dhhs.nh.gov/dphs/nhp/wic/index.htm
xii https://www.dhhs.nh.gov/dphs/bchs/mch/index.htm

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