Smoking is associated with a number of serious health problems and remains the leading cause of preventable death and disease in our nation.¹Smoking during pregnancy is clearly linked to fetal and infant deaths and infants born to mothers who smoked while pregnant have three times the risk on Sudden Infant Death Syndrome.²In addition, smoking can result in low birth-weight and prematurity.³ According to a report from the Surgeon General, 20% of low birth-weight births, 8% of preterm deliveries, and 5% of all prenatal infant deaths could be prevented by eliminating smoking during pregnancy. Other adverse effects may include mental retardation, physical growth retardation, asthma, and other respiratory diseases.⁴Research has recently found that childhood behavioral and cognitive challenges are associated with fetal exposure to tobacco.⁵

Among the 50 largest cities in the United States, Pittsburgh has the highest rate of pregnant women who smoke in the nation. According to a survey conducted by the Annie E. Casey Foundation, 23.3% of women who gave birth in Pittsburgh reported they smoked during pregnancy in 2000.⁶ Pittsburgh has held this ranking for ten out of the last eleven years according to the survey.⁷ Although rates are particularly high in Pittsburgh, high rates of smoking during pregnancy in Pennsylvania are not confined to this region. Philadelphia ranked 30^th out of 50 cities in the Casey survey with 14% of mothers smoking during pregnancy.⁸ Rates are also troubling in many rural counties; in York County, the figure is close to 22%, Clinton County 30%, Venango County 33.4%, and 33.6 % in Greene County.⁹

It is clear that aggressive prevention and cessation programs targeting pregnant women and women of childbearing age are needed across Pennsylvania. Helping even a small number of pregnant women to quit smoking, or not start, can significantly impact health outcomes for their children. Reducing the frequency of smoking during pregnancy can also have a positive effect.¹⁰In addition to the benefits of smoking cessation to our children there are strong economic reasons to want to make a lasting impact; even a small reduction in maternal smoking could mean significant tax savings. According to the Agency for HealthCare Research and Quality, one study shows that reducing smoking by one percent in the United States would prevent 1300 low birth-weight live births, and save $21 million in direct medical costs, including hospital costs and professional fees.¹¹

The Department of Public Welfare’s (DPW) mission is to promote, improve, and sustain the quality of life as well as to serve and protect vulnerable citizens.Approximately one (1) out of every nine (9) Pennsylvanians receives their health care through the Medical Assistance (MA) Program in either the managed care or fee-for-service delivery systems. This represents an obvious and significant opportunity for detection and early intervention efforts.

DPW recently increased coverage for the number of billable counseling sessions and cessation products. The Office of Medical Assistance Programs (OMAP) can broaden DPW’s impact on smoking cessation through interventions targeted to MA consumers and providers. OMAP is proposing a multifaceted Action Plan consisting of interventions that will increase awareness of the dangers of smoking, encourage early intervention, and ultimately improve the health and social status of Pennsylvania’s MA consumers. The proposed interventions include:

• Raising awareness of the dangers of smoking and smoking while pregnant among the general population
• Raising the awareness of smoking around children of all ages, especially newborns
• Educating and equipping First Line Practitioners who are most likely to have primary contact with a woman during pregnancy,including Obstetricians and Gynecologists, Family Planning Clinics, Family Medicine Physicians, Internists, Certified Nurse Midwifes (CNMs), and Prenatal Care Managers, to be able to identify and refer women who smoke, or who are exposed to second hand smoke
• Providing tailored education for Second Line Practitioners who are likely to have contact with a woman during the course of her pregnancy, which includes, Pediatricians, Dentists, Physician Assistant’s, Nurse Practitioners, and Mental Health/Behavioral Health Providers; and
• Conducting an impact assessment.

In adopting this strategy, OMAP will increase its impact on the women and children affected by smoking.