Using Surveillance To Promote Public Health
Examples from the Pregnancy Risk Assessment Monitoring System (PRAMS)

EXECUTIVE SUMMARY PUBLICATION YEAR 2002

Tobacco

Cigarette smoking during pregnancy contributes to a number of adverse birth outcomes, including spontaneous abortion, stillbirth, fetal death, low birth weight, prematurity, and intrauterine growth retardation. Smoking is the most important known preventable risk factor for low birth weight, a leading cause of fetal and neonatal deaths.^10-12 Postpartum exposure to environmental tobacco smoke also puts infants at increased risk for Sudden Infant Death Syndrome (SIDS) and several other health problems, including lower respiratory infection, ear infection, and asthma.¹³

Alabama

Alabama PRAMS data demonstrated higher smoking rates among pregnant women receiving Medicaid than among pregnant women not receiving Medicaid. In 1996, the Alabama Department of Public Health, in collaboration with the University of Alabama, Birmingham, used these data to win $2.5 million as part of a grant from the National Heart, Lung, and Blood Institute. This money was used for a program designed to stop or reduce smoking among pregnant women who receive prenatal care in county health department clinics in eight counties. The intervention, SCRIPT (Smoking Cessation. Reduction in Pregnancy Trial), was a 5-year project consisting of a patient education program using a self-help guide and video, with assistance provided by trained staff members. Initial results from the intervention were published in the American Journal of Obstetrics and Gynecology in 2000.¹⁴ The authors reported that SCRIPT participants were more than twice as likely to quit smoking as members of the control group. Because SCRIPT has been shown to be effective, prenatal care and maternity care staff in the Alabama Department of Public Health are being trained using SCRIPT methods as part of a “best practice” for caring for pregnant smokers in Alabama. The free training, which is carried out throughout the state, began in October 2001 and will continue for 2 years.

The success of the SCRIPT program in Alabama resulted in the formation of the Alabama Tobacco Free Families (ATOFF) Program. The Alabama Department of Public Health and the University of Alabama, Birmingham, received $4.4 million from the National Cancer Institute to further reduce smoking in the eight SCRIPT counties by expanding the focus to include all women of childbearing age and their male partners. The intervention is aimed at increasing public awareness and knowledge of tobacco risks to the mother, fetus, and infant by targeting messages through community organizations (schools, churches, and work sites), professional organizations (health care organizations and providers), and mass media outlets. PRAMS data are being used to monitor smoking rates among pregnant women in the state. The data also serve as a resource to organizations participating in the intervention.

Florida

A governor’s task force in Florida used PRAMS data in the 1997 Florida lawsuit against the tobacco companies. The purpose of the lawsuit was to recover smoking-attributable expenditures made by Florida’s Medicaid program. The lawsuit resulted in the allocation of $11 billion in tobacco settlement money to the state of Florida, which awarded $50,000 per year to the Florida Department of Health for programs to prevent tobacco use. Some of these funds have been allocated to PRAMS to support the collection of an expanded sample of teen-aged mothers; the number of teen mothers in the Florida PRAMS sample has increased from about 500 to nearly 1,000 per year. The prevalence of smoking before, during, and after pregnancy among the teen population is being examined using PRAMS data. In addition, these data are being used to assess the impact of smoking on low birth weight and infant mortality in the state.

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Page last reviewed: 3/24/06
Page last modified: 3/24/06
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion