Adam E. Klein, MD - West Virginia State Medical Association

| Scientific Articleof the teens who had a infant witha low birth score and reportedsmoking during pregnancy.Tobacco Use DuringPregnancy and RaceDifferences in race were foundwhen examining those teen motherswho smoked tobacco duringpregnancy. Of the 6,414 motherswho were Caucasian, 35.1% (n =2254) smoked during pregnancy.This compares to 20.4% (n = 74)of the African American motherswho smoked during pregnancy.Tobacco Use During Pregnancyand Infant Year BornTobacco use during pregnancyvaried depending on the year theinfant was born. There was a declinein the percent of teens reportingtobacco use during pregnancy forthose who gave birth in 2007 and 2008(see Table 1 for breakdown by year).Tobacco Use During Pregnancyand Prenatal CareIn looking at those teens whostarted prenatal care in the firsttrimester, 34.2% (n = 1791) reportedsmoking during pregnancy. Thiscompared to 34.3% (n = 494) whoreported smoking during pregnancyand sought prenatal care duringthe second trimester. For those whostarted prenatal care in the thirdtrimester, 29.3% (n = 65) reportedsmoking during pregnancy. Of thesmall group of teens who did notaccess prenatal care, 40.9% (n = 9)reported smoking during pregnancy.Utilization of prenatal care didnot vary by smoking status. In bothgroups 76% accessed prenatal care inthe first trimester, 21% sought carein their second trimester, and 3%first began their prenatal care in theirthird trimester. Less than 1% of bothgroups did not utilize prenatal care.Those who reported smoking had asimilar number of prenatal visits thanthose who did not smoke (9.58 visitsTable 1. Tobacco Use by YearInfant BornYear Infant Born% (n) of TeensWho SmokedDuringPregnancy2003 35.9 (409)2004 36.2 (375)2005 34.1 (391)2006 36.2 (446)2007 33.1 (414)2008 29.0 (324)Overall 34.1 (2359)compared to 9.83 visits, respectively).While this difference was statisticallysignificant (t=2.820, df = 6920, p =.005), clinically this difference is small(less than one visit in difference).LimitationsThis study did not use a randomlyselected sample, but rather theentire sampling frame of teens whogave birth in West Virginia during2003- 2008. This limits the abilityto generalize results beyond WestVirginia. Additionally, given thevery large sample size (n = 6,922), itis not surprising that all of the Chisquareanalyses conducted on thesevariables resulted in significancelevels of p ≤ .01. According to Cohen(1992 26 ), in Chi-square analysis, effectsizes are small, medium, and large(.10, .30, and .50, respectively). Whenlooking at effect size, however, noneof the relationships that were foundto be significant had either a mediumor large effect size. Consequently,while additional Chi-square analyseswere conducted, only the two Chisquareresults with the highest effectsizes were reported, which were stillvery small in terms of strength ofrelationship. Thus, the majority of theresults of this study should be usedprimarily for descriptive purposesrather than inferential statements.DiscussionThis study examined retrospectivedata on all those adolescentswho gave birth from 2003-2008in West Virginia, as it relates totobacco use during pregnancy.Important information regardingthe demographic and healthcharacteristics of adolescents inWest Virginia who are pregnantand smoking was found.Implications for future research andinterventions are discussed below.Education Level and Tobacco UseThe highest percent of teensreporting tobacco use duringpregnancy were those in the earliergrades (8 th grade or less), followedby those in 9 th and then 10 th grade.While the percentages were lower inthe final two grades in high school,there was still over one quarter ofthe teens who reported smokingduring pregnancy. It was only forthe small group of teens who hadsome college level education thatthe percentages were under 15%.This suggests that school nurses,health teachers, and social workersshould target their interventionstowards younger teens. This can bedone on a larger scale, such as in allhealth classes, as well as for thosestudents who let school staff knowthat they are pregnant and planningto move forward with the pregnancy.Additionally, as part of sexualeducation and/or health classes,it would be beneficial to cover therisk factors associated with smokingduring pregnancy. While a majorityof teens do get pregnant in the lasttwo years of high school, those whoare younger are already at a higherrisk medically and thus should haveeducation as to the health benefits ofnot smoking during pregnancy bothfor themselves and their infants.Birth Weight and Tobacco UseThe results of this study areconsistent with the literature, inJuly/August 2012 | Vol. 108 31