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No smoking for two

A new campaign aims to get pregnant women here to quit

Tuesday, May 01, 2001

By Deborah Mendenhall, Post-Gazette Staff Writer

The latest figures are out and the picture isn't pretty: For the eighth time in nine years, more pregnant women smoked in Pittsburgh than anywhere else in the nation, jeopardizing the health of their unborn babies.

Belinda Stevenson, with son Darwin Lee Stevenson, 2 months, who was the first baby born among participants in a local program called Stop TObacco in Pregnancy. Click (Andy Starnes, Post-Gazette)

One in four expectant mothers smoked in 1998, earning Pittsburgh the highest rate among 41 cities surveyed.

"That's an abysmal record," said Robert Nelkin, director of Policy Initiatives at the University of Pittsburgh's Office of Child Development. "And what's worse is Pittsburgh has been at the bottom from the start."

Pittsburgh's high of 24 percent compares with 2 percent in Miami, which ranked the best and 11 percent in Denver, which was in the middle. The latest statistics were recently released by Kids Count and Child Trends, which conducted a joint survey sponsored by the Annie E. Casey Foundation.

While the national average of expectant smokers declined from 18 percent in 1990 to 11 percent in 1998, Pittsburgh has remained at a steady 25 percent since 1995. Pittsburgh was nudged out of last place only once. In 1990, the first year figures were compiled, Pittsburgh's pregnant smokers numbered 32 percent while Cleveland had 33 percent.

What seems to be unclear is why. None of the experts interviewed could give a reason for Pittsburgh's poor showing.

"We have a lot of literature that says we are the worst, and we know what the consequences are, but I'm not sure anyone knows why, and that probably means we should look into the reasons," said Jan Jernigan, professor and researcher at University of Pittsburgh's Graduate School of Public Health.

Pittsburgh's last-place ranking in 2000 prompted Nelkin to organize a special 60-member coalition to reduce maternal smoking in Allegheny County. It includes members from health care, public health, neighborhoods and universities and is funded with a grant from the Jewish Healthcare Foundation.

Unborn babies at increased risk

Local health officials are sounding a warning that has been well established in numerous medical studies: Smoking during pregnancy places unborn babies at increased risk for a myriad of serious illnesses and even death.

Before birth, the baby is connected to the mother's circulation through the placenta and umbilical cord. Two poisons found in cigarettes -- nicotine and carbon monoxide, the same gas that comes out of a car's exhaust pipe -- pass through to the developing baby. Researchers suspect that these poisons block the nutrients and oxygen that the baby needs to grow properly.

Maternal smoking is responsible for an estimated 30 percent of low-birth weight babies and 14 percent of premature deliveries, according to the American Lung Association. Underweight babies often suffer complications such as under-developed lungs, and require special care and longer hospital stays. Some may die at birth or within the first year.

The Lung Association blames maternal smoking for 10 percent of all infant deaths, including many from Sudden Infant Death Syndrome.

Babies confined to smoke-filled wombs are twice as likely to develop asthma, and at increased risk for learning disabilities. Recent research by theAmerican Heart Association has linked prenatal smoking to behavior and attention problems in children. A study published in the Archives of Pediatric and Adolescent Medicine last year found that 2-year-old children whose mothers smoked during pregnancy were angrier, more unruly and more likely to be depressed than other toddlers.

Mothers who continue to smoke after the baby is born exacerbate the problem by passing nicotine in breast milk. Some researchers fear this will set the child up for tobacco addictions later in life.

For 10 years, Marie Cornelius, associate professor of psychiatry and epidemiology at Pitt, has been studying the offspring of 400 teen-age girls, half of whom are smokers.

Cornelius intended to study the effects of alcohol on children, but soon learned that most girls kicked alcohol and other substances when they learned they were pregnant. Tobacco use, however, stayed the same or increased, and those who tried to quit smoking often relapsed.


More on smoking

A local program enrolls pregnant women. to help them stop smoking.

Doctor's study is aimed at helping teens kick the habit.


Cornelius revised her study to examine the immediate and long-term effects of prenatal and environmental smoking on the children. She has found that by age 6, the children showed increased activity levels, tended to have more behavior and attention problems, and were more oppositional than their peers. They also had more problems in receptive language abilities, or in understanding some words they heard.

Cornelius also looked at older children with Dr. Nancy L. Day, professor of psychiatry and epidemiology at Pitt, who is also conducting research on smoking effects on children. They found that children whose mothers smoked during pregnancy were five times more likely to begin smoking by age 10.

Cornelius and Day were surprised to learn that the children also had higher incidents of obesity, a conclusion they had seen in two other recently published studies.

Low birth weight is caused by lean tissue loss, Cornelius said. Not only do children catch up, but prenatal smoking seems to alter the relationship between body length and weight in the child.

A goal for 2005

Cornelius was one of the local experts tapped by Nelkin when he organized the Smoke Free Mothers/Smoke Free Families coalition last year after Pittsburgh's poor showing in the Kids Count survey.

The 60-member group is driven by a 12-member steering committee, and headed by co-chairmen Nelkin and Dr. Bruce Dixon, director of the Allegheny County Health Department.

After meeting regularly since May, the group created a community-wide tobacco control and prevention plan with a goal to reduce maternal smoking 30 percent by 2005. Other goals include reducing the number of children exposed to second-hand smoke and increasing the number of doctors who refer women of child bearing age for smoking cessation counseling.

The plan is ready to go and is awaiting funding from Pennsylvania's $11 billion share of the $206 billion federal Tobacco Settlement. The agreement was reached in 1998 after 22 states filed lawsuits seeking reimbursement for the high public cost of smoking-related illnesses.

The Smoke Free Coalition is seeking between $100,000 and $150,000 to fund an office and staff member who will work with agencies and leaders in communities and faith-based groups, Nelkin said.

Nelkin is optimistic that the number of Pittsburgh's smoking moms can be reduced. He points to Pittsburgh's success in reducing the infant mortality rates through the federally funded Healthy Start Inc. program, that he helped organize locally.

Faced with the highest infant mortality rate in the nation in 1988-90, with 19.8 deaths for every 1,000 live births, Allegheny County health officials set a goal to cut the rate in half. That goal was achieved in 2000 when the infant mortality rate dropped to 10.5 after Healthy Start stepped up intensive, home-based support for the baby's first year.

Pittsburgh was one of 14 initial cities picked for a Healthy Start program, and became a model.

"So we know we can make a difference," Nelkin said. "When health, civic and government leadership decides on a goal, we can do it."

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