The Effect of Local Smokefree Regulations on Birth Outcomes and Prenatal Smoking
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The Effect of Local Smokefree Regulations on Birth Outcomes and Prenatal Smoking Karla S. Bartholomew1 • Rahi Abouk2
Ó Springer Science+Business Media New York 2016
Abstract Objectives We assessed the impact of varying levels of smokefree regulations on birth outcomes and prenatal smoking. Methods We exploited variations in timing and regulation restrictiveness of West Virginia’s county smokefree regulations to assess their impact on birthweight, gestational age, low birthweight, very low birthweight, preterm birth, and prenatal smoking. We conducted regression analysis using state Vital Statistics individual-level data for singletons born to West Virginia residents between 1995–2010 (N = 293,715). Results Only more comprehensive smokefree regulations were associated with statistically significant favorable effects on birth outcomes in the full sample: Comprehensive (workplace/restaurant/bar ban) demonstrated increased birthweight (29 grams, p \ 0.05) and gestational age (1.64 days, p \ 0.01), as well as reductions in very low birthweight (-0.4 %, p \ 0.05) and preterm birth (-1.5 %, p \ 0.01); Restrictive (workplace/ restaurant ban) demonstrated a small decrease in very low birthweight (-0.2 %, p \ 0.05). Among less restrictive regulations: Moderate (workplace ban) was associated with a 23 g (p \ 0.01) decrease in birthweight; Limited (partial ban) had no effect. Comprehensive’s improvements extended to most maternal groups, and were broadest among mothers 21? years, non-smokers, and unmarried mothers. Prenatal smoking declined slightly (-1.7 %, p \ 0.01) only among married women with Comprehensive. Conclusions
& Karla S. Bartholomew [email protected] 1
School of Medicine and Health Sciences, The George Washington University, 2300 I Street NW, Washington, DC 20037, USA
2
Department of Economics, William Paterson University, Wayne, NJ 07470, USA
Regulation restrictiveness is a determining factor in the impact of smokefree regulations on birth outcomes, with comprehensive smokefree regulations showing promise in improving birth outcomes. Favorable effects on birth outcomes appear to stem from reduced secondhand smoke exposure rather than reduced prenatal smoking prevalence. This study is limited by an inability to measure secondhand smoke exposure and the paucity of data on policy implementation and enforcement. Keywords Tobacco use Regulations Pregnancy Low birth weight Preterm infants
Significance What is known on this subject? Smokefree regulations have the potential to improve birth outcomes by decreasing smoking prevalence among pregnant women and/or reducing secondhand smoke exposure during pregnancy. Research is limited, though, and does not yet provide a consensus statement. What does this study add? To our knowledge, this is the first direct evaluation of varying degrees of regulation restrictiveness (comprehensive versus partial ban) on and the only long-term evaluation of birth outcomes and prenatal smoking. Also, most previous studies have utilized aggregate data; our study uses
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