PERINATAL TOBACCO USE

Transcription

1 PERINATAL TOBACCO USE Child Fatality Task Force Meeting December 7, 2015 Erin McClain, MA, MPH You Quit, Two Quit, UNC Center for Maternal & Infant Health

2 Percentage Women & Tobacco Use in NC BRFSS survey found that 16.5% of women in NC report current tobacco use Proportion is higher among low-income women, women with less than a college education, and rural women NC State Center for Health Statistics. Available from:

3 Tobacco Use During Pregnancy in NC 3 Almost 1 in 10 babies in NC are born to women reporting tobacco use during pregnancy In some counties over 30% of babies are born to women who used tobacco Among low-income families and in rural areas, proportion is significantly higher than the state average Progress has been made, but not fast enough 2011 = 10.9% 2012 = 10.6% 2013 = 10.3% 2014 = 9.8%

4 Tobacco Use Causes Poor Birth & Infant Outcomes 4 Maternal/Fetal Harm From Tobacco Infant/Child Harm From Tobacco Infertility Miscarriage Ectopic Pregnancy Premature Birth Low Birth Weight Stillbirth SIDS SIDS Ear infections Respiratory Infections Asthma Links with childhood obesity, cancer, & attention disorders, and cardiovascular disease & diabetes in adulthood Tobacco use during pregnancy is directly associated with the top 4 causes of infant mortality in NC

5 5 Prenatal Tobacco Use & Neonatal Abstinence Syndrome (NAS) NAS increased 511% between in NC From to per 100,000 live births 70-90% of pregnant women in substance abuse treatment also use tobacco Heavier smoking among opioid-maintained women is associated with lower birth weight and smaller birth length Dose-response between the daily number of cigarettes smoked and the severity of NAS, including: total amount of morphine needed to treat NAS, number of days medicated for NAS, neonatal length of hospital stay in days, and is negatively associated with 1- and 5-min Apgar scores N.C. State Center for Health Statistics. Injury and Epidemiology and Surveillance Unit. Neonatal Abstinence Syndrome Haug NA, Stitzer ML, Svikis DS. Smoking during pregnancy and intention to quit: a profile of methadone-maintained women. Nicotine & Tobacco Research. November 1, ;3(4): Jones H, Heil S, O'Grady K, et al. Smoking in pregnant women screened for an opioid agonist medication study compared to related pregnant and non-pregnant patient samples. The American journal of drug and alcohol abuse. 2009;35(5): Winklbaur B, Baewert A, Jagsch R, Rohrmeister K, Metz V, Aeschbach Jachmann C, Thau K, Fischer G. Association between prenatal tobacco exposure and outcome of neonates born to opioid-maintained mothers. Implications for treatment. Eur Addict Res. 2009; 15(3): Jones HE, Heil SH, Tuten M, Chisolm MS, Foster JM, O'Grady KE, Kaltenbach K. Cigarette smoking in opioid-dependent pregnant women: neonatal and maternal outcomes. Drug Alcohol Depend. 2013; 131(3):271-7.

6 6 ENDS & Reproductive Age Women Not currently regulated and have not been shown to be a safe or effective cessation aid The health effects of using e-cigarettes & other ENDS before or during pregnancy have not been adequately studied Nicotine is a known reproductive toxicant and has adverse effects on fetal development, including lung and brain development The use of smokeless tobacco products, such as snus, during pregnancy has been associated with preterm delivery, stillbirth, and infant apnea Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health. Information for Health Care Providers and Public Health Professionals: Preventing Tobacco Use During Pregnancy. Available from:

7 ENDS and Children & Youth 7 Youth use of e-cigarettes (13.4%) now surpasses use of traditional cigarettes (9.2%) Exposures to e-cigarettes & liquid nicotine reported to Poison Control jumped 156% from 2013 to 2014, and 14-fold since ,452 through 9/30/15

8 Tobacco Use Affects NC Economically 8 Annual health care costs in North Carolina directly caused by smoking $3.81 billion Portion covered by the NC Medicaid program $931.4 million Residents' state & federal tax burden from smoking-caused government expenditures $889 per household Smoking-caused productivity losses in North Carolina $4.24 billion These amounts do not include health costs caused by exposure to secondhand smoke, smoking-caused fires, smokeless tobacco use, or cigar and pipe smoking. Tobacco use also imposes additional costs, such as damage to property. Campaign for Tobacco-Free Kids. The Toll of Tobacco in NC. Updated 9//25/15. Available from:

9 Tobacco Cessation is Cost Effective 9 Quitting smoking can lower total health care costs within 2 years Cessation treatment in the outpatient setting lowers health care costs within 18 months of quitting. Within 3 years, a former smoker s health care costs will be at least 10% less than if they continued smoking. Tobacco screening is estimated to result in lifetime savings of $9,800 per person Compared to other preventive health interventions, tobacco cessation has one of the lowest costs per life-year-saved Hockenberry, J, et. al. Healthcare Costs Around the Time of Smoking Cessation. Am J Prev Med 2012;42(6): Making the Business Case for Smoking Cessation Programs: 2012 Update A report by Leif Associates. Solberg, LI, et al, Repeated Tobacco-Use Screening and Intervention in Clinical Practice. Am J Prev Med. 2006;31(1): Cromwell J, et al1997). Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Healthcare Policy and Research. JAMA, 278:

10 ROI of Tobacco Cessation During Pregnancy 10 For every $1 invested in tobacco cessation for pregnant women, at least $3 are saved in healthcare costs. Ruger JP, Emmons KM. Economic evaluations of smoking cessation and relapse prevention programs for pregnant women: a systematic review. Value Health Mar-Apr;11(2):

11 What is NC Doing to Protect Moms & Babies? 11 Cessation Support QuitlineNC Key component of care management for Medicaidinsured pregnant women through the Pregnancy Medical Home Initiative E-cigarettes & other ENDS NC one of 16 states requiring child-proof liquid nicotine packaging E-cigarettes classified as a tobacco product and not for sale <18 yrs. System Supports Medicaid & private insurers reimburse for cessation counseling Provider training and TA through You Quit, Two Quit (funded by Duke Endowment through 6/2016) Title V Performance Measure Evidence-based cessation counseling required in local health departments Women and Tobacco Coalition for Health (WATCH) Nationally-recognized Guide for Counseling Women Who Smoke

12 What Else Would Help Protect Moms & Babies? 12 Ensure Clinicians & Community Health Workers Provide Comprehensive Tobacco Cessation for Women Support and expand efforts of You Quit, Two Quit Nationally-recognized, evidence-based quality improvement initiative Provides high-quality provider education and office-based technical assistance to improve tobacco screening and treatment Teaches evidence-based approaches to helping pregnant & postpartum women quit tobacco Provides academic detailing to improve office flow, documentation, and clinicbased evaluation Works with wide variety of obstetric and primary care providers, including private practices, health departments, federally-qualified and rural health centers, and residency clinics What is needed? $250,000/year for 3 years

13 13 Questions? Erin McClain