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

Scientific Article |that those who smoke tobaccoduring pregnancy have babies withsignificantly lower birth weights.This is a major concern, given thatlow birth weight has been found tobe the primary predictor of infantmortality. 25 Also in a recent studyusing the West Virginia Birth Scoredata for all women in the state, “theaverage birth weight of infants bornto mothers who smoked was 3039grams compared to the averagebirth weight of infants born tomothers who did not smoke of 3289grams” (p. 18). 25 This is similar to theresults found in the West Virginiateen population as well. The mainissue at hand here is the desire ofteen girls to reduce weight gainand manage stress, as well havea less painful delivery. Currently,using tobacco is a way that theseteens can effectively achieve thesegoals. The next step in researchwould be to examine the knowledgelevels of teen girls in regards to thehealth impact of low-birth weighton infants and its connection toinfant mortality. Future researchis needed to thoroughly explorehow teens negotiate the decisionto use tobacco during pregnancy,specifically considering issues suchas their fears about delivery, theirknowledge levels of alternativedelivery strategies to reduce painduring childbirth, their healthconcerns for their infants, and theinfluence of whether the pregnancywas desired or not. It is important tonote that any provider developingan intervention in this particulararea needs to use a developmentalapproach, given that the cognitiveand socio-emotional maturity levelof the teen is certainly a factor intheir ability to successfully negotiatethis decision-making process.Birth Score and Tobacco UseIt is not surprising that therewas a higher percentage of teenmothers who reported smokingduring pregnancy and who also hadan infant with a high birth score.Smoking during pregnancy is one ofthe seven questions on the Birth Scorescreen and it does add points towardsthe total score if answered “yes”.While not all seven variables thatmake up the total birth score wereexamined in this study, four othervariables besides smoking duringpregnancy were analyzed, includingprior pregnancies, birth weight,maternal education, and maternalage. These four variables all showedhigher percents of teens who reportedsmoking during pregnancy as well,indicating that the birth score screenis a valuable tool for identifying thosewho may need additional educationand resources on tobacco cessation.In another West Virginia studythat used the Birth Score data onwomen of all ages who gave birthbetween 2001 and 2009, Mullett andcolleagues found that 28.5% of thewomen had reported using tobaccoduring pregnancy (2010). 25 This islower than the 34.1% of teens in thisstudy’s sample who reported usingtobacco during pregnancy. Theresults of this study confirm whatwas found in the larger study ofall women. Mullett and colleaguesfound that women who had an infantwith a high birth score were morelikely to report tobacco use duringpregnancy (53.7%) compared withthose women who used tobaccoduring pregnancy and had an infantwith a low birth score (23.6%). 25Year of Birth and Tobacco UseWhile over one third of the sampleconsistently reported using tobaccoduring pregnancy during 2003-2007,2008 was the first year that thispercentage dropped to 29%. This maybe in part due to efforts to increasestatewide surveillance of tobaccouse as well as to create evidencebased,comprehensive smokingcessation programs since 2007. 27Race and Tobacco UseSimilar to the rest of the country,there was a higher percentage ofCaucasian teens who reportedsmoking during pregnancy, ascompared to their African Americanteen counterparts. Authors havesuggested the rates are higher forCaucasian teens because they aremore likely to live with someone whosmokes, to see a parent or guardiansmoke, to have friends who smoke,and lastly, they are less likely tohave a smoking ban in their homesthan African American teens. 28Given that smoking rates are higherfor teens in West Virginia than therest of the nation, those engagingin research and interventions inthis area should consider thattobacco use might be perceived asnormative for adolescents and thusinvolvement by key stakeholdersJoinWESPAC Now!West Virginia StateMedical Association’sPolitical Action CommitteeVisit www.wvsma.com orCall 304.925.0342, ext. 2532 West Virginia Medical Journal