Page 1

DRAFT– do not distribute  DRAFT - DO NOT DISTRIBUTE

Smoking During Pregnancy  in Wisconsin and the United States  Trends and Patterns, 1990‐2010 

May 2012 


Acknowledgements

 

This report was prepared by Karen A. Palmersheim, Ph.D. Dr. Palmersheim is an epidemiologist and researcher with the University of Wisconsin-Milwaukee, Center for Urban Initiatives and Research. Support for this report was provided by Wisconsin Department of Health Services, Division of Public Health, Bureau of Community Health Promotion, Tobacco Prevention and Control Program. The author wishes to thank Randall L. Glysch and Peter E. Maier for their helpful reviews of the report. Suggested citation: Palmersheim KA. Smoking During Pregnancy in Wisconsin and the United States: Trends and Patterns, 1990-2010. Milwaukee, Wisconsin: University of Wisconsin-Milwaukee Center for Urban Initiatives and Research, 2012. For additional copies of this report, visit our website cuir.uwm.edu or contact: Karen Palmersheim, Ph.D. University of Wisconsin-Milwaukee Center for Urban Initiatives and Research P.O. Box 413 Milwaukee, WI. 53201 palmersh@uwm.edu

Table of Contents Executive Summary ................................................................................................................................ 1 Introduction ............................................................................................................................................. 3 Results .................................................................................................................................................... 4 Discussion ............................................................................................................................................... 9 Limitations ............................................................................................................................................. 10 Technical Notes .................................................................................................................................... 10 References ............................................................................................................................................ 11 Appendix of Data Tables ....................................................................................................................... 12 Table 1 ............................................................................................................................................... 12 Table 2 ............................................................................................................................................... 12 Table 3 ............................................................................................................................................... 13 Table 4 ............................................................................................................................................... 14 Table 5 ............................................................................................................................................... 14


Executive Summary This report describes trends in cigarette smoking during pregnancy from 1990 to 2010 in Wisconsin for all pregnant women and demographic subgroups. United States data are compared to Wisconsin data for the years 1990 through 2007. The data presented reveal the following major patterns in smoking during pregnancy:

National •

In the United States, the prevalence of smoking during pregnancy decreased from 18% in 1990 to 9% in 2007.

State •

In Wisconsin, the prevalence of smoking during pregnancy decreased from 23% in 1990 to 15% in 2007; It decreased to 13% in 2010.

The relative percent decrease in smoking during pregnancy was 42% between 1990 and 2010. However, the rate of change has been small and the direction of change has been inconsistent during the most recent eight years (i.e., 14% in 2003, 15% in 2006, 13% in 2010).

Race •

During 2008-2010, 5% of Laotian/Hmong women, 6% of Hispanic women, 15% of non-Hispanic white women, 16% of non-Hispanic black women, and 37% of American Indian women reported smoking during pregnancy.

For all racial and ethnic groups, other than Laotian/Hmong women, the prevalence of smoking during pregnancy decreased between 1990 and 2010.

American Indian women had the highest prevalence of smoking during pregnancy throughout the study period.

Though Laotian/Hmong women consistently had the lowest prevalence of smoking during pregnancy, they are the only group for whom prevalence increased between 1993 and 2010 (from 0% during 19931995 to 5% during 2008-2010).

The prevalences of smoking during pregnancy for non-Hispanic black, Hispanic, American Indian, and Laotian/Hmong women in Wisconsin were approximately double the prevalence for each corresponding group in the United States.

Age •

In general, women 18 to 24 years of age were most likely to smoke during pregnancy (~23%).

When age and race/ethnicity were considered in tandem, the prevalence of smoking during pregnancy for black women was greater for older age groups. Black women 20 years of age and older were almost twice as likely to smoke during pregnancy compared to black women less than 20 years of age. Smoking during pregnancy among American Indian women was consistently higher among women aged 18 to 34 years, compared to the youngest group and the two oldest groups.


Executive Summary, continued... Education •

In general, the prevalence of smoking during pregnancy was lower for women in each sequentially higher category of educational attainment during 1990 through 2010.

However, women with less than a high school diploma were less likely to smoke during pregnancy than women with at high school degree during 2008-2010.

Compared to women with a college degree or greater, women with a high school diploma and those with less than a high school degree were at least twelve times more likely to smoke during pregnancy during 2008-2010 (2%, 24%, and 23%, respectively).

Women with some college were approximately seven time more likely to smoke during pregnancy than women with a college degree (13% and 2%, respectively).

Marital Status •

The prevalence of smoking during pregnancy decreased for both married and unmarried women between 1990 and 2010; however, during 1990-1992, unmarried women were about two and one-half times more likely to smoke during pregnancy than married women (40% vs. 16%); during 2008-2010, they were greater than four times more likely to smoke (27% vs. 6%).

Prenatal Care •

Compared to women who initiated prenatal care during the first trimester of their pregnancy, women who initiated care during their second or third trimester were nearly one and one-half times more likely to smoke during pregnancy; women who did not receive prenatal care were almost two and one-half times more likely to smoke (13%, 19%, and 31%, respectively).

Wisconsin Counties •

A decreasing trend in the prevalence of smoking during pregnancy was observed in 67 of Wisconsin’s 72 counties between 1990-1992 and 2008-2010. However, from 2005-2007 to 2008-2010, an increase in the prevalence of smoking during pregnancy was noted in 26 counties.

During 2008-2010, the average prevalence of smoking during pregnancy among Wisconsin women was 13.9%; however, in 52 of the state’s counties, the prevalences were higher than the state average.

The prevalence of smoking during pregnancy varied greatly among counties. During 2008-2010, Ozaukee County had the lowest prevalence (7%) and Menominee County had the highest prevalence (39%).

In general, higher prevalences of smoking during pregnancy were observed in the northern third of the state, and in a number of centrally located counties.


Introduction Cigarette smoking during pregnancy has been shown to have adverse effects on both the mother and child. Two reports of the Surgeon General, Women and Smoking1 and The Health Consequences of Smoking,2 highlight the dangers of smoking during pregnancy. Pregnant women who smoke put themselves and their babies at risk for premature rupture of membranes, placenta previa, stillbirth, preterm delivery, and sudden infant death syndrome. These reports also show that infants born to women who smoke are at least twice as likely to be low birthweight, defined as weighing less than 2,500 grams at birth. In Wisconsin, during 2008-2010, 11.1% of babies born to women who smoked were low birthweight babies, compared to 6.4% of babies born to non-smoking women. Comparison of the 2008-2010 data to 2005-2007 data reveals virtually no change in the relative percentages of low birthweight babies for women who smoked during pregnancy relative to non-smoking women. The infant mortality rate for the babies of Wisconsin mothers who smoked during their pregnancy was 9.4 deaths per 1,000 live births in 2008-2010. For the babies of mothers who did not smoke, the infant mortality rate was 5.7 deaths per 1,000 live births.3 Wisconsin has long recognized the great risks a woman who smokes takes for herself, her unborn child, and her family. Through many programs with local health departments, coalitions, health care professionals, and interested partners, the state has focused efforts at reducing tobacco use and exposure to secondhand smoke in the general population. In addition, the state supports the First Breath4 program, a nationally-recognized smoking cessation program for pregnant women established in 2001. Healthy People 20105 outlined an ambitious objective of increasing abstinence from cigarettes among pregnant women to 99%. In addition, one of the goals of Healthiest Wisconsin 2010,6 Wisconsin’s state health plan, includes eliminating health disparities. In light of these goals, the purpose of this report is to examine trends in smoking during pregnancy among women in Wisconsin. It compares the prevalence of smoking during pregnancy in Wisconsin to the prevalence in the United States for all pregnant women and for select subgroups. The data for this report came primarily from the Wisconsin Interactive Statistics on Health (WISH)3 (see Technical Notes). Additionally, this report serves as an update to the 2006 and 2009 reports, Smoking During Pregnancy in Wisconsin and the United States: Trends and Patterns, 1990-2004,7 and Smoking During Pregnancy in Wisconsin and the United States: An Update in Trends and Patterns, 1990-2007.8

Pregnant women who smoke put themselves and their babies at risk for premature rupture of membranes, placenta previa, stillbirth, pre-term delivery, and sudden infant death syndrome. … infants born to women who smoke are twice as likely to be low birthweight… Healthy People 2010 outlined an ambitious objective of increasing abstinence from cigarettes among pregnant women to 99%.

This report identifies social and demographic characteristics associated with an increased likelihood of smoking during pregnancy. However, none of the relationships presented in this report should be construed as causal. Findings presented here are intended to provide a resource for health professionals, local health departments, and local coalitions working towards the reduction of the prevalence of smoking during pregnancy in Wisconsin. This report may also assist public health agencies attempting to assess progress in the reduction of smoking during pregnancy, and aid in the determination of focusing future efforts.


Results   Figure 1. Trends in the prevalence of smoking during pregnancy, Wisconsin and the United States, 1990-2010 25%

The percentages of pregnant women who smoked in the United States and Wisconsin 20% from 1990 to 2007, and 2010, Wisconsin respectively, are shown in Figure 1. Both the United States 15% United States* and Wisconsin experienced significant declines in the percentage of women who smoked dur- 10% ing pregnancy. In the United States, the prevalence of smoking during pregnancy decreased 5% from 18.4% in 1990 to 9.3% in 2010 Goal: 1% 2007, a relative decrease of ‡ 0% 49.5% . During the same time 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 period, the prevalence of smoking during pregnancy among Wisconsin women decreased from 22.9% to 14.9%, Overall, this represents a 42% relative decrease during representing a relative decrease of 34.9%. Between the 21-year study period. However, most of the change 2007 and 2010, the prevalence of smoking among preg- occurred during the first 13 years, with little appreciable nant women in Wisconsin decreased further to 13.3%. change occurring during the last eight years. Data for Figure 1 are located in Table 1 of the appendix.

Figure 2. Prevalence of smoking during pregnancy by race/ethnicity, Wisconsin and the United States, 2007 Figure 2 provides a comparison of the prevalence of smoking during pregnancy among racial and ethnic groups in Wisconsin with the average prevalence among those groups nationwide in 2007.

40%

For non-Hispanic white women, the prevalence of smoking during pregnancy in Wisconsin was slightly greater than that observed for the United States. The prevalences of smoking during pregnancy for non-Hispanic black, American Indian, Hispanic, and Laotian/Hmong women in Wisconsin were almost double the prevalence for each corresponding group in the United States. Table 2 of the appendix demonstrates the persistence of these disparities across time.

25%

United States 35%

Wisconsin 30%

20% 15% 10% 5% 0% Non-Hispanic Non-Hispanic White Black

American Indian

Hispanic

Laotian/ Hmong

Data for Figure 2 are located in Table 2 of the appendix. ‡

Relative percent change provides a standard comparison between populations with different initial prevalences. Relative percent change is calculated by subtracting the prevalence for the initial time period from the prevalence of the most recent time period, and dividing the result by the prevalence of the initial time period. This number is then multiplied by 100% to get the relative percent change = [(% in 2008-2007 - % in 1990-1992) ÷ % in 1990-1992] x 100%.


Results   Figure 3. Prevalence of smoking during pregnancy by race/ethnicity, Wisconsin, 1990-2010 by threeyear averages 60%

Trends in the prevalence of smoking during pregnancy for racial and ethnic groups in Wisconsin from 1990 to 2010 are illustrated in Figure 3 using three-year averages. For all racial/ethnic groups except than Laotian/ Hmong, the prevalence of smoking during pregnancy decreased during this period. American Indian women had the highest prevalence of smoking during pregnancy throughout the study period, 48.0% in 19901992 and 36.9% in 2008-2010. Laotian/ Hmong women consistently exhibited the lowest prevalence of smoking during pregnancy, although their rates have been steadily increasing, from 0.4% in 1993-1995 to 5.2% in 2008-2010.

50%

American Indian

40%

Black

30%

White 20% Hispanic 10% Laotian /Hmong 0% 1990-1992 1993-1995 1996-1998 1999-2001 2002-2004 2005-2007 2008-2010

The relative percent decrease in the prevalence of smoking during pregnancy was greatest for Hispanic women (-65.6%), and was smallest for American Indian

women (-24.4%) and non-Hispanic white women (-30.0%) between 1990-1992 and 2005-2007.

Data for Figure 3 are located in Table 3 of the appendix.

Figure 4. Prevalence of smoking during pregnancy by age of mother, Wisconsin, 1990-2010, by threeyear averages In general, younger women are more likely to smoke during pregnancy than older women, as seen in Figure 4. More specifically, women aged 18-19 or 20-24 years were most likely to smoke during pregnancy during 2008-2010 (22.5% and 22.4%, respectively). The age groups next most likely to smoke during pregnancy were those less than 18 years of age (12.7%) and those 25-29 years of age (13.2%). Smoking during pregnancy was lowest among women in the three highest age groups (8.3%, 7.7%, and 7.6%, respectively).

40% 35%

Under 18

18-19 yrs

20-24 yrs

30-34 yrs

35-39 yrs

40+ yrs

25-29 yrs

30% 25% 20% 15% 10% 5% 0% 1990-1992

Data for Figure 4 are located in Table 3 of the appendix.

5 

1993-1995

1996-1998

1999-2001

2002-2004

2005-2007

2008-2010


Results   Figure 5. Prevalence of smoking during pregnancy by race/ethnicity and age, Wisconsin, 2008-2010 The age distribution of smoking during pregnancy varies slightly relative to racial/ ethnic background (Figure 5). For most racial/ethnic groups, the prevalence of smoking during pregnancy is lower among the older age groups. Among Black women, however, the prevalence of smoking during pregnancy tends to be comparatively high among the five oldest groups. Laotian/Hmong women aged 35 years and older were not included due to small sample sizes.

50%

Under 18 yrs

45%

18-19 yrs

40%

20-24 yrs

35%

25-29 yrs

30%

30-34 yrs

25%

35-39 yrs

20%

40+ yrs

15% 10% 5%

Data for Figure 5 are located in Table 4 of the appendix.

0%

Non-Hispanic White

Non-Hispanic Black

American Indian

Hispanic

Laotian/ Hmong

Figure 6. Prevalence of smoking during pregnancy by educational attainment, Wisconsin, 1990-2010, by three-year averages 50%

The prevalence of smoking during pregnancy decreased among women in every level of educational attainment between 1990 and 2010 (Figure 6). In addition, the greatest relative percent decrease was observed among women with less than a high school education (-43.6%), with this group falling below women with a high school diploma during 2008-2010. Yet, educational disparities in smoking during pregnancy persist. Compared to women with a college degree, those with some college were approximately 7 times more likely to smoke during pregnancy during 2008-2010 (1.8% vs.12.8%). Women with less than a high school degree (22.6%) and those who were high school graduates (24.3%) were more than 12 times as likely to smoke during their pregnancy.

45%

Less than high school

40% 35% High school graduate

30% 25% 20%

Some college

15% 10% 5%

College graduate

0% 1990-1992 1993-1995 1996-1998 1999-2001 2002-2004 2005-2007 2008-2010

Data for Figure 6 are located in Table 3 of the appendix.

6 


Results   Figure 7. Prevalence of smoking during pregnancy by marital status, Wisconsin, 1990-2010 by threeyear averages The prevalence of smoking for married and unmarried pregnant women decreased between 1990 and 2010, as illustrated in Figure 7. However, smoking during pregnancy was consistently more likely to be observed among women who were unmarried than among women who were married. In addition, the ratio of the prevalence of smoking during pregnancy for unmarried to married women increased over time. During 1990-1992, unmarried women were about two and one-half times more likely to smoke during pregnancy than married women (40.2% vs. 16.3%); by 2008-2010, they were more than four times more likely to smoke (26.5% vs. 6.4%).

45%

Married

40%

Not Married

35% 30% 25% 20% 15% 10% 5% 0%

1990-1992 1993-1995 1996-1998 1999-2001 2002-2004 2005-2007 2008-2010

Data for Figure 7 are located in Table 3 of the appendix.

Figure 8. Prevalence of smoking during pregnancy by trimester of prenatal care, Wisconsin, 19902010, by three-year averages Smoking during pregnancy was less likely to be observed among women who received prenatal care during the first trimester of their pregnancy than those who initiated care later or not at all (Figure 8). This relationship remained consistent throughout the study period. During 2008 -2010, pregnant women who received no prenatal care were greater than one and one-half times more likely to smoke compared to women who received care in the second or third trimesters, and two and one-half times more likely to smoke than women who received care in the first trimester. In addition, between 2005-2007 and 2008-2010, the prevalence of smoking during pregnancy increased among women not receiving care (27.6% and 31.4%, respectively).

45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 1990-1992

1993-1995

First trimester

Data for Figure 8 are located in Table 3 of the appendix.

7 

1996-1998

1999-2001

2002-2004

Second or third trimester

2005-2007

2008-2010

No prenatal care


Results   Figure 9 presents the prevalence of smoking during pregnancy among Wisconsin’s counties (divided into quartiles). During the years 2008-2010, Ozaukee County had the lowest prevalence (6.8%) and Menominee County had the highest prevalence (39.0%). The overall averaged prevalence of smoking during pregnancy in Wisconsin for these years was 13.9%; however, 52 counties had a prevalence of smoking that was higher than the statewide average. The median prevalence of smoking during pregnancy for Wisconsin’s counties was 17.7%, reflecting a slightly skewed distribution. This distribution is due to more populous counties in Wisconsin generally having a lower prevalence of smoking during pregnancy than less populous counties. In addition, the map reveals a greater tendency for women living in the northern counties, and a group of centrally located counties to smoking during pregnancy. During the overall study period, decreases in the prevalence of smoking during pregnancy were observed in 67 counties, increases were observed in 3 counties, and no change was observed in 1 county.* However, between 2005-2007 and 2008-2010, decreases were observed in 42 counties, increases were observed in 26 counties, and no change was observed in 3 counties. (Data for Wisconsin counties are located in Table 5 of the appendix.) Figure 9. Prevalence of smoking during pregnancy by county, in quartiles, Wisconsin, 2008-2010

Douglas

Bayfield Iron Ashland

Burnett

Washburn

Vilas

Sawyer

Florence Oneida

Price Polk

Barron

Forest Marinette

Rusk Lincoln Langlade

Taylor St. Croix

Chippewa

Menominee

Dunn

Marathon Eau Claire

Pierce

Shawano

Clark

Pepin

Wood

Buffalo

Oconto

Portage Waupaca

Jackson

Door

Kewaunee Outagamie Brown

Trempealeau Adams La Crosse

Waushara

Monroe Juneau

Marquette

Calumet Manitowoc Winnebago

Green Lake Fond du Lac Sheboygan

Vernon Richland

6.8%-12.9%

22.1%-39.0%

Columbia

Dodge Washington Ozaukee

Crawford Iowa

13.0%-17.7% 17.8%-22.0%

Sauk

Dane

Waukesha Jefferson Milwaukee

Grant Lafayette

Green

Rock

Walworth

Racine Kenosha

* Data on smoking were not available for Florence County for 2008-2010 due to small sample size.

City of Milwaukee 12.1%


  Discussion Overall, the prevalence of smoking during pregnancy decreased in both Wisconsin and the United States during the period examined in this study. In the United States, the prevalence of smoking during pregnancy decreased from 18% in 1990 to 9% in 2007. In Wisconsin, the prevalence of smoking during pregnancy decreased from 23% in 1990 to 15% in 2007, and further decreased to 13% in 2010. This decline in smoking during pregnancy indicates that efforts focused on the reduction of smoking among pregnant women, and in the general population, are having an impact. In fact, the prevalence of smoking among pregnant women in Wisconsin decreased by 41.9% (relative percent change) between 1990 and 2010. However, the majority of this decline (-38.9% relative decrease) occurred during the first 14 years of the study period. Since 2003, there has been little change in maternal smoking in Wisconsin. And despite clear evidence on the risks that smoking presents to both a woman and her unborn child, more than 9,000 women in Wisconsin still smoked during their pregnancies in 2010.3 In addition, the prevalence of smoking during pregnancy is not equally distributed within Wisconsin’s population. For example, among racial/ethnic groups in Wisconsin, American Indian women were most likely to smoke during their pregnancy, while Hispanic and Laotian/Hmong women were least likely to smoke. Moreover, the differences in the prevalence of smoking during pregnancy between Wisconsin and the United States varied by race/ethnicity. While the prevalence of smoking during pregnancy for non-Hispanic white women in Wisconsin was slightly greater than that observed in the United States overall, the prevalence for each minority group in Wisconsin was twice the national prevalence for each respective group in 2007. The prevalence of smoking during pregnancy also varied by the age of the woman. In general, younger women (18 to 24 years of age) were more likely to smoke during pregnancy than their older peers. However, this pattern was not consistent across all racial/ethnic groups. Specifically, among black women, older cohorts were more likely to smoke during pregnancy compared to their younger counterparts. Other studies have shown that, in general, the likelihood of a black woman smoking is actually greater among older age groups due to later initiation of smoking and decreased cessation.9 This pattern appears to hold true for pregnant women as well. In addition, the relatively high prevalence of maternal smoking among American Indian women was persistent among women aged 18 to 34 years. Thus, programs designed to reduce the incidence of smoking during pregnancy among specific racial/ethnic groups may need to take these age related differences into account. Level of educational attainment has traditionally been a strong and consistent predictor of maternal smoking, represented by an inverse association between education and smoking. However, during the two most recent 3-year time periods examined in this study, the prevalence of smoking during pregnancy among women with the lowest level of education (less than a high school degree) dropped below that of women who are high school graduates. Yet, during 2008-2010, women with a high school education or less were 12 times more likely to smoke than women with a college degree or greater. Women with some college education were 7 times more likely to smoke than women with a college degree. Marital status and prenatal care also provide important indicators of smoking during pregnancy, especially for physicians. Although this report presents no evidence signifying either factor as a cause of smoking during pregnancy, both can be used to identify women who may be in particular need of smoking cessation advice. Specifically, pregnant women who are not married, and those initiating prenatal care during the later stages of their pregnancy are at greater risk of smoking during pregnancy. Women who do not seek prenatal care at all are also at high risk of smoking during pregnancy, and present a unique challenge to the public health system. Considerable progress has been made in reducing the prevalence of smoking among pregnant women in Wisconsin, and in the United States overall. However, the lofty goal of Healthy People 2010, to increase abstinence from cigarettes among pregnant women to 99%, and the goal of Healthiest Wisconsin 2010, to eliminate health [related] disparities, are yet to be achieved. It will likely take a concerted, sustained effort among public health agencies, healthcare personnel, and other groups working with pregnant women to realize these goals in Wisconsin.

9 


Limitations   The relationships presented in this report do not imply causality. The evidence displayed here do not suggest that any specific demographic or behavioral characteristic causes a woman to smoke during pregnancy. There are a number of limitations associated with birth certificate data. The data on smoking are self-reported. Thus, the possibility that women underreport tobacco use during pregnancy exists, particularly if there was a poor birth outcome. In addition, while the wording on the birth certificate has remained the same over the years, it may not be asked in the same manner by each health professional at each hospital. Some health professionals may ask the questions in a way that biases a woman’s self-report of tobacco use.

Technical Notes Maternal cigarette use is based on the mother’s report of smoking during pregnancy. Information on smoking during pregnancy is obtained from the woman during prenatal care visits or at the time of delivery, and is recorded on the birth certificate by the attending physician, nurse, or other health professional at the time of delivery. Data presented in this report are from the 1989 U.S. Standard Certificate of Live Birth. The 1989 version reports smoking at any time during pregnancy. In 2003, the 1989 version of the birth certificate was revised with regards to how smoking is assessed. The 2003 revision assesses cigarette use during the three months prior to pregnancy and by each trimester of pregnancy. Wisconsin, along with many other states and reporting areas, continued to use the 1989 version through 2010. However, as more states and reporting areas have begun to use the 2003 revision, comparable U.S data (those using the 1989 birth certificate) are not being reported or published in readily accessible databases. Thus, this report could only include comparable U.S. data through 2007. As of 2007, the 1989 Standard Certificate of Live Birth was used in 24 States, New York City, and Washington, DC.

Wisconsin data in this report were accessed from the Wisconsin Interactive Statistics on Health (WISH) website, http://dhfs.wisconsin.gov/wish/. The information in the WISH birth-related modules is from Wisconsin resident birth certificate data. Data were primarily analyzed in seven three-year time periods (1990-1992, 1993-1995, 1996 -1998, 1999-2001, 2002-2004, 2005-2007, 2008-2010). United States data used in this report were accessed from several sources, including: - Annual editions of the National Center for Health Statistic’s publication: Health, United States, with Chartbook on Trends in the Health of Americans - U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Women's Health USA 2010. Rockville, Maryland: U.S. Department of Health and Human Services, 2010. Online version available at: http://mchb.hrsa.gov/whusa10/ - The CDC’s National Center for Health Statistics (http://www.cdc.gov/nchs/index.htm) - The CDC’s online database “WONDER” (http://wonder.cdc.gov/) - The CDC’s National Vital Statistics System (http://www.cdc.gov/nchs/nvss.htm) Additional examination of data for the city of Milwaukee showed the prevalence of smoking during pregnancy was 12.1% during 2008-2010.

10 


References 1. U.S. Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001. 2. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2004. 3. Wisconsin Department of Health and Family Services. Wisconsin Interactive Statistics on Health (WISH). Available at: http://dhfs.wisconsin.gov/wish/. Last accessed April 27, 2012. 4. Wisconsin Women’s Health Foundation. First Breath. Website: http://www.wwhf.org/pg_firstbreath.asp. Accessed April 20, 2012. 5. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. Washington, DC: U.S. Government Printing Office; 2000. 6. Wisconsin Department of Health and Family Services. Healthiest Wisconsin 2010: A Partnership Plan to Improve the Health of the Public; 2002. Available at: http://dhs.wisconsin.gov/statehealthplan/shp-pdf/ pph0276phip.pdf. Accessed April 20, 2012. 7. Jovaag AR, Palmersheim KA, Ullsvik JC, Kvale K, Umland MA, Wegner MV. Smoking During Pregnancy in Wisconsin and the United States: Trends and Patterns, 1990-2004. Madison, Wisconsin: University of Wisconsin Comprehensive Cancer Center, Tobacco Surveillance and Evaluation Program; 2006. Available at: http://sep.uwcarbone.wisc.edu/. 8. Hinterthuer CR, Palmersheim KA. Smoking During Pregnancy in Wisconsin and the United States: An Update on Trends and Patterns, 1990-2007. Madison, Wisconsin: University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Tobacco Surveillance and Evaluation Program; 2009. Available at: http:// www4.uwm.edu/cuir/research/tobacco-s_e-archive.cfm. 9. Moon-Howard J. African American women and smoking: starting later. Am J Public Health. 2003;93(3): 418420.

11 


  Appendix of Data Tables

Table 1. Trends in the prevalence of smoking during pregnancy, Wisconsin and the United States, 1990-2010

Table 2. Prevalence of smoking during pregnancy by race and ethnicity and the rate ratio, Wisconsin and the United States, 1990, 1995, 2000, and 20052007* United States

Ratio of Rates Wisconsin : US

22.5%

21.0%

1.1

18.9%

17.1%

1.1

2000

17.1%

15.6%

1.1

14.6%

2005

14.3%

13.9%

1.1

18.9%

13.9%

2006

15.9%

13.3%

1.2

18.2%

13.6%

2007

16.0%

12.7%

1.3

1997

17.9%

13.2%

1998

17.8%

12.9%

1990

29.6%

15.9%

1.9

1999

17.1%

12.6%

1995

24.1%

10.6%

2.3

2000

16.5%

12.2%

2000

19.6%

9.2%

2.1

2001

15.8%

12.0%

2005

14.9%

8.5%

1.8

2002

14.8%

11.4%

2006

16.5%

8.0%

2.1

2003

14.0%

10.7%

2007

16.6%

7.7%

2.2

2004

14.0%

10.3%

2005

13.4%

10.7%

2006

14.9%

10.0%

2007

14.9%

9.3%

2008

14.1%

--

2009

14.2%

--

2010

13.3%

--

Relative percent change

1990 to 2007 -34.9%

1990 to 2007 -49.5%

Relative percent change

1990 to 2010 -41.9%

--

Wisconsin

United States

1990

22.9%

18.4%

1991

22.5%

17.8%

1990

1992

21.6%

16.9%

1995

1993

20.7%

15.8%

1994

19.6%

1995 1996

Wisconsin Non-Hispanic White

Non-Hispanic Black

American Indian 1990

46.5%

22.4%

2.1

1995

47.1%

20.9%

2.3

2000

39.5%

20.0%

2.0

2005

35.2%

17.8%

2.0

2006

37.7%

16.5%

2.3

2007

35.9%

16.5%

2.2

1990

15.2%

6.7%

2.3

1995

10.2%

4.3%

2.4

2000

6.7%

3.5%

1.9

2005

4.9%

2.9%

1.7

2006

5.5%

2.6%

2.1

2007

5.7%

2.1%

2.7

1.9%

2.4

Hispanic

-- = Comparable data not available

Laotian/Hmong** 2007

4.5%

* Comparable U.S. data only available through 2007 ** Sample size was too small to be reliable prior to 2007

12 


21,505 2,501 5,934 3,518

Non-Hispanic Black

American Indian

Hispanic

Laotian /Hmong

13 

14,375 51,481 71,832 50,855 16,630 2,490

18-19 yrs

20-24 yrs

25-29 yrs

30-34 yrs

35-39 yrs

40+ yrs

87,245 48,925 42,400

High school graduate

Some college

College graduate

54,285

Not Married

or 3 trimester

rd

1,679

37,590

175,784

-- = data not available due to small sample size

No prenatal care

2

nd

1 trimester

st

Trimester prenatal care initiated

161,049

Married

Marital status

34,991

< High school

Education

7,658

Under 18

Age

180,306

215,337

Non-Hispanic White

Race/ethnicity

Wisconsin (total)

# of live births

42.7%

31.3%

20.2%

40.2%

16.3%

4.2%

15.7%

26.9%

43.1%

13.7%

15.4%

17.2%

19.9%

30.0%

32.9%

25.4%

--

15.7%

48.0%

28.7%

22.0%

22.3%

Smoking Prevalence

1990-1992

1,633

31,502

181,194

74,073

141,889

65,862

53,141

61,723

33,017

5,013

24,228

51,542

66,097

50,562

12,765

5,748

3,644

20,034

3,356

20,965

163,339

215,993

# of live births

27.6%

20.2%

13.3%

28.0%

7.4%

2.0%

12.4%

24.1%

24.8%

8.8%

7.9%

8.0%

13.4%

23.4%

24.4%

15.1%

4.6%

5.4%

36.3%

16.0%

15.4%

14.4%

Smoking Prevalence

2005-2007

1,429

31,055

175,872

78,388

132,682

66,898

55,397

57,918

29,572

4,843

22,201

52,932

66,316

47,738

12,168

4,930

3,988

20,511

3,432

21,362

156,908

211,193

# of live births

31.4%

18.9%

12.8%

26.5%

6.4%

1.8%

12.8%

24.3%

22.6%

7.6%

7.7%

8.3%

13.2%

22.4%

22.5%

12.7%

5.2%

5.8%

36.9%

15.8%

14.7%

13.9%

Smoking Prevalence

2008-2010

-26.5%

-39.6%

-36.6%

-34.1%

-60.7%

-57.1%

-18.5%

-9.7%

-47.6%

-46.1%

-50.0%

-51.7%

-33.7%

-25.3%

-31.6%

-50.0%

--

-63.1%

-23.1%

-44.9%

-33.2%

-37.7%

Relative Change (%) 1990-1992 to 2008-2010

13.8%

-6.4%

-3.8%

-5.4%

-13.5%

-10.0%

3.2%

0.8%

-8.9%

-13.6%

-2.5%

3.8%

-1.5%

-4.3%

-7.8%

-15.9%

13.0%

7.4%

1.7%

-1.3%

-4.5%

-3.5%

Relative Change (%) 2005-2007 to 2008-2010

Table 3. Number of live births, prevalence of smoking during pregnancy and relative percent change, by select maternal characteristics, Wisconsin, 1990-1992, 2005-2007, and 2008-2010, by three-year averages

 


Table 4. Prevalence of smoking during pregnancy by race/ethnicity and age, Wisconsin, 2008-2010

 

Non-Hispanic White

Non-Hispanic Black

American Indian

Hispanic

Laotian /Hmong

# of live births

Smoking Prevalence

# of live births

Smoking Prevalence

# of live births

Smoking Prevalence

# of live births

Smoking Prevalence

# of live births

Smoking Prevalence

< 18 yrs

1,858

22.5%

1,605

4.8%

194

27.8%

1,041

5.5%

192

9.4%

18-19 yrs

6,497

33.0%

2,881

9.8%

418

37.8%

1,858

6.8%

389

5.9%

20-24 yrs

31,117

26.9%

7,637

16.3%

1,166

38.8%

5,705

8.3%

1,420

6.4%

25-29 yrs

52,065

13.4%

5,003

20.0%

894

38.9%

5,679

5.4%

1,099

5.3%

30-34 yrs

43,499

8.1%

2,791

18.1%

483

35.6%

4,028

3.7%

536

2.2%

35-39 yrs

17,902

7.6%

1,180

18.7%

233

29.2%

1,834

2.8%

268

--

40+ yrs

3,958

7.6%

256

16.4%

43

27.9%

365

3.6%

84

--

-- = data not available due to small sample size

Table 5. Number of live births, prevalence of smoking during pregnancy, rank, and relative percent change, Wisconsin counties, 1990-1992, 2005-2007, and 2008-2010, by three-year averages Total live Smoking Rank births Prevalence 2008-2010 2008-2010 2008-2010 Wisconsin

211,193

13.9%

Adams Ashland Barron Bayfield Brown Buffalo

490 582 1,550 372 10,293 411

28.8% 30.2% 22.0% 23.1% 11.5% 15.8%

Burnett Calumet Chippewa Clark Columbia Crawford

430 1,822 2,317 1,750 1,914 538

Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron

Relative Relative Smoking Smoking change (%) change (%) Prevalence Prevalence 1990-1992 to 2005-2007 to 1990-1992 2005-2007 2008-2010 2008-2010 22.3%

14.4%

-37.7%

-3.5%

65 67 54 56 12 30

36.1% 32.7% 25.1% 32.0% 22.3% 17.2%

33.2% 32.4% 19.4% 25.5% 13.6% 18.9%

-20.2% -7.6% -12.4% -27.8% -48.4% -8.1%

-13.3% -6.8% 13.4% -9.4% -15.4% -16.4%

34.7% 9.0% 19.9% 11.6% 18.8% 18.0%

70 4 45 14 40 38

33.4% 16.9% 25.2% 20.2% 24.2% 23.0%

35.8% 8.6% 21.8% 13.4% 15.5% 16.0%

3.9% -46.7% -21.0% -42.6% -22.3% -21.7%

-3.1% 4.7% -8.7% -13.4% 21.3% 12.5%

18,399 2,710 739 1,441 1,348 3,492

8.5% 17.4% 12.9% 20.4% 15.8% 17.0%

3 35 18 48 29 34

16.4% 22.0% 19.7% 29.0% 19.7% 20.8%

9.5% 18.9% 12.9% 20.8% 16.4% 16.6%

-48.2% -20.9% -34.5% -29.7% -19.8% -18.3%

-10.5% -7.9% 0.0% -1.9% -3.7% 2.4%

103 3,404 321 1,713 1,240 639

-11.2% 30.7% 12.4% 16.7% 19.7%

-10 68 16 32 43

33.6% 21.8% 35.3% 23.7% 19.5% 20.4%

13.7% 14.8% 31.7% 13.2% 15.0% 18.1%

--48.6% -13.0% -47.7% -14.4% -3.4%

--24.3% -3.2% -6.1% 11.3% 8.8%

928 128

15.4% 28.4%

26 64

20.1% 33.5%

14.8% 23.6%

-23.4% -15.2%

4.1% 20.3%

14 


Table 5. (continued from previous page)

 

Jackson Jefferson

738 2,931

24.4% 15.5%

59 27

28.6% 25.0%

28.0% 19.1%

-14.7% -38.0%

-12.9% -18.8%

Juneau Kenosha Kewaunee La Crosse Lafayette Langlade

822 6,535 644 4,051 627 589

27.2% 14.4% 10.2% 14.3% 10.5% 28.9%

63 22 7 21 8 66

30.8% 28.3% 15.8% 20.4% 17.3% 29.9%

25.8% 15.4% 13.0% 16.1% 13.1% 26.0%

-11.7% -49.1% -35.4% -29.9% -39.3% -3.3%

5.4% -6.5% -21.5% -11.2% -19.8% 11.2%

Lincoln Manitowoc Marathon Marinette Marquette Menominee

920 2,550 5,003 1,169 466 333

26.3% 19.7% 17.7% 25.2% 19.7% 39.0%

61 42 36 60 44 71

26.1% 22.7% 16.9% 26.9% 28.6% 45.0%

22.1% 21.7% 17.8% 24.2% 25.3% 45.2%

0.8% -13.2% 4.7% -6.3% -31.1% -13.3%

19.0% -9.2% -0.6% 4.1% -22.1% -13.7%

Milwaukee Monroe Oconto Oneida Outagamie Ozaukee

44,926 1,933 1,133 942 6,888 2,379

11.2% 20.2% 20.7% 21.0% 12.7% 6.8%

11 47 50 51 17 1

24.7% 27.8% 26.7% 26.1% 15.4% 12.6%

11.5% 19.2% 20.4% 22.4% 11.8% 7.1%

-54.7% -27.3% -22.5% -19.5% -17.5% -46.0%

-2.6% 5.2% 1.5% -6.3% 7.6% -4.2%

Pepin Pierce Polk Portage Price Racine

251 1,246 1,477 2,276 337 7,740

10.8% 9.1% 21.8% 11.6% 18.1% 14.7%

9 5 53 15 39 23

20.5% 19.2% 28.2% 17.5% 25.3% 25.9%

15.8% 13.7% 22.8% 12.6% 16.9% 14.0%

-47.3% -52.6% -22.7% -33.7% -28.5% -43.2%

-31.6% -33.6% -4.4% -7.9% 7.1% 5.0%

Richland Rock Rusk St. Croix Sauk Sawyer

652 6,047 467 3,341 2,343 556

16.3% 18.0% 22.5% 9.2% 23.2% 31.3%

31 37 55 6 57 69

19.7% 28.5% 24.8% 17.6% 25.8% 41.5%

19.1% 20.2% 22.5% 8.9% 21.9% 26.3%

-17.3% -36.8% -9.3% -47.7% -10.1% -24.6%

-14.7% -10.9% 0.0% 3.4% 5.9% 19.0%

Shawano Sheboygan Taylor Trempealeau Vernon Vilas

1,330 4,074 741 1,157 1,284 567

21.8% 14.1% 15.0% 15.1% 13.5% 23.5%

52 20 24 25 19 58

22.0% 21.1% 19.2% 24.6% 18.7% 37.0%

23.1% 14.2% 17.2% 16.1% 10.8% 26.1%

-0.9% -33.2% -21.9% -38.6% -27.8% -36.5%

-5.6% -0.7% -12.8% -6.2% 25.0% -10.0%

Walworth Washburn Washington Waukesha Waupaca Waushara

3,413 482 4,434 11,593 1,640 671

15.8% 26.3% 11.6% 7.5% 19.4% 20.6%

28 62 13 2 41 49

22.9% 26.3% 17.9% 15.0% 26.8% 27.7%

15.3% 26.4% 11.6% 8.2% 20.2% 20.5%

-31.0% 0.0% -35.2% -50.0% -27.6% -25.6%

3.3% -0.4% 0.0% -8.5% -4.0% 0.5%

5,788 17.0% 33 Winnebago 2,633 20.0% 46 Wood -- = data not available due to small sample size

22.2% 22.7%

15.7% 19.2%

-23.4% -11.9%

8.3% 4.2%

15 


Smoking During Pregnancy in Wisconsin and the United States Trends and Patterns 1990-2010  

Health and Wellness

Read more
Read more
Similar to
Popular now
Just for you