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Morbidity and Mortality Weekly Reports (MMWRs)

State Estimates of Neonatal Health-Care Costs Associated with Maternal Smoking —United States, 1996

October 7, 2004 / Vol. 53 / No. 39

MMWR Highlights

• The Maternal and Child Health Smoking-Attributable Mortality, Morbidity, and Economic Costs (MCH SAMMEC) software provided a national estimate of smoking-attributable neonatal expenditures of $366 million in 1996, or $704 per maternal smoker.
• Across areas, higher total SAE estimates by MCH SAMMEC were associated with higher numbers of births and higher smoking prevalence. SAE totals ranged from $34 million in California to $537,661 in the District of Columbia (DC).
• After California, states with the highest SAEs were New York, Ohio, Pennsylvania, and Texas; states with the lowest SAEs were Alaska, Hawaii, Vermont, and Wyoming.
• Although overall prevalence of maternal smoking was 13.2% in 1997, prevalence by area ranged from 4.8% in New York City to 25.3% in West Virginia (4).
• To focus on the population at risk for excess costs in and across areas, SAEs per maternal smoker were estimated. SAEs per maternal smoker ranged from $519 in Hawaii to $1,334 in DC.
• Although higher smoking prevalence usually is associated with white mothers as compared with blacks, smoking prevalence was higher among black mothers in 13 states and DC. Among black mothers in these 13 states, smoking prevalence ranged from 6.7% to 21.3%, and SAE per maternal smoker ranged from $1,008 to $1,403.
• Among all states, the average SAE for black mothers was almost double that for white mothers ($1,207 versus $651). However, adverse outcomes among black infants are more likely regardless of maternal smoking; at least one study suggests stronger effects of smoking on birthweight among black women compared with white women.
• In every area except DC, Indiana, and Mississippi, smoking prevalence was higher for women aged <20 years than for women aged >20 years. In all areas, the prevalence of smoking among pregnant women with less education was more than double the prevalence of women with more education.
• Persons who were uninsured or who were on Medicaid while pregnant had greater smoking prevalence than those with private or other health insurance. In all areas except DC and Texas, the prevalence of smoking among Medicaid/uninsured mothers was >10%; prevalence was highest in Indiana (37.7%).
• The highest SAE per maternal smoker among the Medicaid/uninsured group was in DC ($1,355); the lowest was in Hawaii ($523).
• Among women in the private/other insurance group, smoking prevalence was <10% in 28 states. The average SAEs per maternal smoker, from all areas, were $753 for those in the Medicaid/uninsured group and $626 for those in the private/other insurance group.
• Mothers who are on Medicaid or uninsured are less likely to initiate prenatal care in the first trimester.
• Both the prevalence of maternal smoking and SAE per maternal smoker were higher for mothers who began prenatal care in the third trimester or who had no prenatal care, compared with mothers who received prenatal care in the first or second trimester.
• The average SAEs per maternal smoker ranged from $485 in Hawaii to $1,112 in DC for mothers beginning care in the first or second trimester and from $821 to $2,166 in the same two areas for women beginning prenatal care in the third trimester, or having no care at all.

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