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Associations of tobacco control policies with birth outcomes.

Abstract：

IMPORTANCE:It is unclear whether the benefits of tobacco control policies extend to pregnant women and infants, especially among racial/ethnic minority and low socioeconomic populations that are at highest risk for adverse birth outcomes. OBJECTIVE:To examine the associations of state cigarette taxes and the enactment of smoke-free legislation with US birth outcomes according to maternal race/ethnicity and education. DESIGN, SETTING, AND PARTICIPANTS:Using a quasi-experimental approach, we analyzed repeated cross sections of US natality files with 16,198,654 singleton births from 28 states and Washington, DC, between 2000 and 2010. We first used probit regression to model the associations of 2 tobacco control policies with the probability that a pregnant woman smoked (yes or no). We then used linear or probit regression to estimate the associations of the policies with birth outcomes. We also examined the association of taxes with birth outcomes across maternal race/ethnicity and education. EXPOSURES:State cigarette taxes and smoke-free restaurant legislation. MAIN OUTCOMES AND MEASURES:Birth weight (in grams), low birth weight (<2500 g), preterm delivery (<37 weeks), small for gestational age (<10th percentile for gestational age and sex), and large for gestational age (>90th percentile for gestational age and sex). RESULTS:White and black mothers with the least amount of education (0-11 years) had the highest prevalence of maternal smoking during pregnancy (42.4% and 20.0%, respectively) and the poorest birth outcomes, but the strongest responses to cigarette taxes. Among white mothers with a low level of education, every $1.00 increase in the cigarette tax reduced the level of smoking by 2.4 percentage points (-0.0024 [95% CI, -0.0004 to -0.0001]), and the birth weight of their infants increased by 5.41 g (95% CI, 1.92-8.89 g). Among black mothers with a low level of education, tax increases reduced smoking by 2.1 percentage points (-0.0021 [95% CI, -0.0003 to -0.0001]), and the birth weight of their infants increased by 3.98 g (95% CI, 1.91-6.04 g). Among these mothers, tax increases also reduced the risk of having low-birth-weight, preterm, and small-for-gestational-age babies, but increased the risk of having large-for-gestational-age babies. Associations were weaker among higher-educated black women and largely null among higher educated white women and other groups. We did not find evidence for an association of smoke-free restaurant legislation with birth outcomes. CONCLUSIONS AND RELEVANCE:Increases in the cigarette tax are associated with improved health outcomes related to smoking among the highest-risk mothers and infants. Considering that US states increase cigarette taxes for reasons other than to improve birth outcomes, these findings are welcome by-products of state policies.

journal_name

JAMA Pediatr

journal_title

JAMA pediatrics

authors

Hawkins SS,Baum CF,Oken E,Gillman MW

doi

10.1001/jamapediatrics.2014.2365

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

e142365

issue

eissn

2168-6203

issn

2168-6211

pii

1919922

journal_volume

168

pub_type

杂志文章

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Associations of tobacco control policies with birth outcomes.