Florida

1
Floridas Increasing Prevalence of Smoking During
Pregnancy The Impact of Revising the Birth
Certificate

• Presented by Angel Watson, MPH, RHIA
• Florida State University, Consultant to Florida
  Department of Health,
• Division of Family Health Services, Office of
  Surveillance, Evaluation and Epidemiology

2
Overview

• Although the prevalence of smoking during
  pregnancy has declined it remains a major public
  health issue.
• Smoking during pregnancy is associated preterm
  premature rupture of membranes, abruptio
  placentae, placenta previa and preterm delivery.

Source The Centers for Disease Control and
Prevention, Maternal and Infant Health Smoking
During Pregnancy http//www.cdc.gov/reproductivehe
alth/maternalinfanthealth/related/smokingpregnancy
.htm
3
Overview

• A Healthy People 2010 goal is to reduce tobacco
  use during pregnancy to no more than 1.
• In 2005 Floridas Smoking During Pregnancy rate
  was 9.6.

4
Study Objective

• To what extent does the revision of the birth
  certificate and changes in reporting contribute
  to Floridas increasing prenatal smoking
  prevalence?

5
Methods

• Analyzed Florida Pregnancy Risk Assessment
  Monitoring Systems (PRAMS) matched with birth
  records (2001-2004).
• Examined smoking trends
• Florida Birth Certificate
• PRAMS
• Explored other surveillance data trends
• Behavior Risk Factor Surveillance System (BRFSS)
• Youth Risk Behavior Surveillance System (YRBSS)

6
2003 Revised Birth Certificate Implementation

• Florida adopted the revised birth certificate
  during March, 2004
• The tobacco use question was revised

7
U.S. Standard Certificate of Live Birth, Smoking
Question
37. CIGARETTE SMOKING BEFORE AND DURING
PREGNANCY For each time period, enter either the
number of cigarettes or the number of packs of
cigarettes smoked. IF NONE, ENTER 0. Average
number of cigarettes or packs of cigarettes
smoked per day. of cigarettes of
packs Three Months Before Pregnancy
___________ OR __________ First Three Months
of Pregnancy ___________ OR
__________ Second Three Months of Pregnancy
___________ OR __________ Third Trimester of
Pregnancy ___________ OR
__________
Data Source National Center for Health
Statistics, http//www.cdc.gov/nchs/data/dvs/birth
11-03final-ACC.pdf
8
Floridas Certificate of Live Birth Smoking
Question

• Tobacco Use During Pregnancy?
• Yes (if yes, avg. no. cigarettes/day)
• Yes, but quit
• No
• Lead to a change in the calculation for tobacco
  use.

9
Study Questions Examined

• Revised tobacco use question
• Tobacco Use During Pregnancy?
• Yes (if yes, avg. no. cigarettes/day)
• Yes, but quit (Quit)
• No

10
Study Questions Examined

• PRAMS Smoking Questions
• In the 3 months before you got pregnant, how many
  cigarettes did you smoke on an average day?
• In the last 3 months of your pregnancy, how many
  cigarettes did you smoke on an average day?
• 41 or more
• 21 to 40
• 11 to 20
• 6 to 10
• 1 to 5
• Less than 1
• None (0 cigarettes)

11
Analysis

• These data were analyzed with Stata SE 9
• PRAMS percentages were weighted, to reflect the
  population of Florida

12
Results
13
Prevalence of Smoking During Pregnancy, Birth
Certificate
14
Prevalence of Smoking During Pregnancy, PRAMS
15
Prevalence of Smoking During Pregnancy, Birth
Certificate and PRAMS
16
Prevalence of Smoking During Pregnancy, Birth
Certificate
17
Prevalence of Smoking During Pregnancy, PRAMS
18
Prevalence of Smoking, Behavioral Risk Factor
Surveillance System, BRFSS
19
Prevalence of Smoking, Youth Risk Behavior
Survey, (YRBSS)
20
Prevalence of Smoking During Pregnancy, Birth
Certificate by Quarter
21
Who are the quitters?
  2004 Birth Certificate Response 2004 Birth Certificate Response 2004 Birth Certificate Response  
PRAMS Response Yes Quit No Total
Yes, Before Pregnancy 6.4 0.6 2.7 10
Quit, 3rd Trimester 0.3 0.7 11.0 12
No 0.8 0.1 77.4 78
Total 7.5 1.4 91.1 100.0
22
Public Health Implications

• Many states are in the process of implementing
  the latest birth certificate revision, these
  revisions may alter prevalence and trends.
• These trends may impact policy and program
  decision making.

23
Thank you,Angel_Watson_at_doh.state.fl.us