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Abstract
Despite the well documented evidence of health consequences of maternal smoking, one million pregnant women continue to smoke in the United States. The year 2000 health objectives for the nation have set new targets to reduce the proportion of women who smoke during pregnancy and reduce low birth weight (LBW) rate. An essential solution to achieve these objectives is dissemination of smoking cessation interventions for pregnant women. The purpose of this study is to conduct multi-disciplinary analyses of the behavioral, health, and economic impact of dissemination. Population attributable risk, cost of illness, and cost-effectiveness analyses were employed in the study.
Smoking during pregnancy was responsible for 20-26% of LBW, 5-9% of preterm delivery, 9% of late fetal death, and 7% of infant death in the U.S. in 1987. Net incremental costs of LBW due to smoking range from $13,515 to \$30,147 in direct cost, and from $24,460 to \$50,154 in indirect cost per LBW. By comparison, net incremental costs of LBW by all causes are higher across all cost categories than LBW due to smoking. The differences in costs between two LBW groups are up to 13% in direct costs and 24% in indirect costs. Direct costs of maternal smoking are $744 to \$2,175 per pregnant smoker while its indirect cost are $1,348 to \$3,620. For every dollar spent on cigarette smoking by pregnant smokers, the society would have to pay additional $4--11 for its health consequences. By reducing smoking rate during pregnancy to 10\%, the U.S. health care system would save \$38 million to $1 billion.
Dissemination of smoking cessation methods in the U.S. during the 1990's would annually help 32,000 to 148,000 and cumulatively 526,000 to 1,093,000 pregnant smokers to quit smoking. Annually 1,500 to 6,000 and cumulatively 29,000 to 44,000 LBW births would be prevented between 1991 and 2000. Average dissemination cost per LBW prevented is $1,409. Net incremental health care cost saving per LBW infant due to dissemination ranges from \$12,106 to $28,738. Dissemination would produce health care cost saving of \$70-166 million dollars annually with cost-effectiveness ratios: 1:9-21 and cost-benefit ratio 1:6-12. Dissemination would also help to achieve 37% to 75% and 12% to 18% of the year 2000 objectives for pregnancy smoking prevalence and low birth weight rates.
The behavioral, health, and economic benefits of dissemination have justified its implementation. Dissemination should be one of national priorities in maternal and child health and given the special public attention and resources it deserves.
