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Maternal Smoking and the Timing of WIC Enrollment

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Abstract

Objective: To investigate the association between the timing of enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and smoking among prenatal WIC participants. Methods: We use WIC data from eight states participating in the Pregnancy Nutrition Surveillance System (PNSS). We adjust the association between the timing of WIC participation and smoking behavior with a rich set of maternal characteristics. Results: Women who enroll in WIC in the first trimester of pregnancy are 2.7% points more likely to be smoking at intake than women who enroll in the third trimester. Among participants who smoked before pregnancy and at prenatal WIC enrollment, those who enrolled in the first trimester are 4.5% points more likely to quit smoking 3 months before delivery and 3.4% points more likely to quit by postpartum registration, compared with women who do not enroll in WIC until the third trimester. However, among pregravid smokers who report quitting by the first prenatal WIC visit, first-trimester enrollment is associated with a 2% point increase in relapse by postpartum registration. These results differ by race/ethnicity; white women who enroll early are 3.6% points more likely to relapse, while black women are 2.5% points less likely to relapse. Conclusions: Early WIC enrollment is associated with higher quit rates, although changes are modest when compared to the results from smoking cessation interventions for pregnant women. Given the prevalence of prenatal smoking among WIC participants, efforts to intensify WIC’s role in smoking cessation through more frequent, and more focused counseling should be encouraged.

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Notes

  1. The Pregnancy Nutrition Surveillance System (PNSS) monitors the health and nutritional status of low-income pregnant women and infants in federally funded programs. The overwhelming majority of women in the PNSS are enrolled in WIC: http://www.cdc.gov/pednss.

  2. http://www.cdc.gov/pednss/pnss_tables/pdf/national_table11.pdf.

  3. http://www.cdc.gov/pednss/what_is/pnss/index.htm.

  4. Arguably the most influential study of WIC based on linkages between birth certificates and administrative data is the 1992 article by Devaney, Bilheimer, and Schore [21]. Remarkably, there was no indicator for smoking. More recent linkages have relied on the dichotomous question, “Did you smoke during pregnancy?” which is available on birth certificates. There is no indication on the timing of smoking or whether the woman has changed the amount she smokes. Thus, a woman who smoked in the first trimester but then quit should technically answer yes but it is unclear how many do [20, 22, 23].

  5. There is more than one possible category of relapsers. One consists of smokers who quit by prenatal WIC enrollment and are marked as having resumed by postpartum registration. Another is the group of women who were still smoking at prenatal WIC, reported quitting sometime within the last 3 months of pregnancy, and resumed postpartum. We chose the first category because of the clearer sequence between exposure to WIC and changing the smoking decision. That is, a woman quits before prenatal WIC, has a chance to hear reinforcing antismoking advice by enrollment, then has the period until the postpartum interview to stay quit or relapse. For the second category, capturing smokers who quit during WIC exposure is more difficult as these women may have very little time to quit between enrollment and the last 3 months of pregnancy. This would be particularly problematic for 3rd-trimester participants, e.g., those enrolling in the 8th month of pregnancy who only had until month 9 to quit.

  6. http://www.cdc.gov/brfss/.

  7. We used the cutoffs as reported by Alexander, et al. (1998) [38].

  8. These states have data for both gestation and smoking outcomes.

  9. Because there has been little change in smoking in the states and years of our sample, we do not include cigarette prices in this model. Following Levy and Meara (2006), we tested changes in smoking around the time of the 1998 Master Settlement Agreement [39]. Consistent with the authors’ findings, we did not find any significant difference in smoking after the settlement.

  10. The standard regression in the literature pools all races and ethnicities and includes dichotomous indicators for each. Our specification is equivalent to a fully interacted model by race and ethnicity. The difference is potentially important because smoking varies dramatically by race and ethnicity.

  11. For most women, registration for prenatal care precedes enrollment in WIC.

  12. We use the routine in Stata 9.2 to obtain marginal effects. In the case of dichotomous indicators such as the trimester of WIC enrollment, the routine reports the difference in the probability of the outcome with the indicator on and then off holding constant the other covariates at their mean values.

References

  1. U.S. Department of Health, Human Services. (2004). The health consequences of smoking: A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

    Google Scholar 

  2. National Center for Health Statistics. Health United States. (2006). With chartbook on trends in the health of Americans. Hyattsville, MD.

  3. Buescher, P. A. (1997). Smoking in pregnancy in North Carolina. North Carolina Medical Journal, 58(5), 356–360.

    CAS  PubMed  Google Scholar 

  4. Boyd, N. R., Windsor, R. A., Perkins, L. L., & Lowe, J. B. (1998). Quality of measurement of smoking status by self-report and saliva cotinine among pregnant women. Maternal and Child Health Journal, 2(2), 77–83. doi:10.1023/A:1022936705438.

    Article  CAS  PubMed  Google Scholar 

  5. Kharrazi, M., Epstein, D., Hopkins, B., Kreutzer, R., Doebbert, G., Hiatt, R., et al. (1999). Evaluation of four maternal smoking questions. Public Health Reports, 114(1), 60–70. doi:10.1093/phr/114.1.60.

    Article  CAS  PubMed  Google Scholar 

  6. Mullen, P. D., Carbonari, J. P., Tabak, E. R., & Glenday, M. C. (1991). Improving disclosure of smoking by pregnant women. American Journal of Obstetrics and Gynecology, 165(2), 409–413.

    CAS  PubMed  Google Scholar 

  7. Kramer, M. D., Taylor, V., Hickok, D. E., Daling, J. R., Vaughan, T. L., & Hollenbach, K. A. (1991). Maternal smoking and placenta previa. Epidemiology (Cambridge, Mass), 2(3), 221–223. doi:10.1097/00001648-199105000-00012.

    CAS  Google Scholar 

  8. Monica, G., & Lilja, C. (1995). Placenta previa, maternal smoking and recurrence risk. Acta Obstetricia et Gynecologica Scandinavica, 74(5), 341–345. doi:10.3109/00016349509024425.

    Article  CAS  PubMed  Google Scholar 

  9. Spinillo, A., Capuzzo, E., Colonna, L., Solerte, L., Nicola, S., & Guaschino, S. (1994). Factors associated with abruptio placentae in preterm deliveries. Acta Obstetricia et Gynecologica Scandinavica, 73(4), 307–312. doi:10.3109/00016349409015768.

    Article  CAS  PubMed  Google Scholar 

  10. Williams, M. A., Mittendorf, R., Stubblefield, P. G., Lieberman, E., Schoenbaum, S. C., & Monson, R. R. (1992). Cigarettes, coffee, and preterm premature rupture of the membranes. American Journal of Epidemiology, 135(8), 895–903.

    CAS  PubMed  Google Scholar 

  11. U.S. Department of Health and Human Services. (2001). Women and smoking: A report of the surgoen general. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

    Google Scholar 

  12. Besharov, D., & Germanis, P. (2000). Evaluating WIC. Evaluation Review, 24(2), 123–190.

    Article  CAS  PubMed  Google Scholar 

  13. Bitler, M., & Currie, J. (2005). Does WIC Work? The effects of WIC on pregnancy and birth outcomes. Journal of Policy Analysis and Management, 24(1), 73–91. doi:10.1002/pam.20070.

    Article  PubMed  Google Scholar 

  14. Bitler, M., & Currie, J. (2005). The changing association between prenatal participation in WIC and birth outcomes in New York City: What does it mean? Journal of Policy Analysis and Management, 24(4), 687–690. doi:10.1002/pam.20132.

    Article  PubMed  Google Scholar 

  15. Joyce, T., Gibson, D., & Colman, S. (2005). The changing association between prenatal participation in WIC and birth outcomes in New York City. Journal of Policy Analysis and Management, 24(4), 661–685. doi:10.1002/pam.20131.

    Article  PubMed  Google Scholar 

  16. Joyce, T., Racine, A., & Yunzal-Butler, C. (2008). Reassessing the WIC effect: Evidence from the pregnancy nutrition surveillance system. Journal of Policy Analysis and Management, 27(2), 277–303. doi:10.1002/pam.20325.

    Article  PubMed  Google Scholar 

  17. Ludwig, J., & Miller, M. (2005). Interpreting the WIC debate. Journal of Policy Analysis and Management, 24(4), 691–701. doi:10.1002/pam.20133.

    Article  PubMed  Google Scholar 

  18. Institute of Medicine. (2007). Preterm birth: Causes, consequences, and prevention. Washington, DC: National Academies Press.

    Google Scholar 

  19. Goldenberg, R. L., & Culhane, J. F. (2007). Low birth weight in the United States. The American Journal of Clinical Nutrition, 85(2), 584S–590S.

    CAS  PubMed  Google Scholar 

  20. Ahluwalia, I., Hogan, V., Grummer-Strawn, L., Colville, W., & Peterson, A. (1998). The Effect of WIC participation on small-for-gestational-age births: Michigan, 1992. American Journal of Public Health, 88(9), 1374–1377. doi:10.2105/AJPH.88.9.1374.

    Article  CAS  PubMed  Google Scholar 

  21. Devaney, B., Bilheimer, L., & Schore, J. (1992). Medicaid costs and birth outcomes: The effects of prenatal WIC participation and the use of prenatal care. Journal of Policy Analysis and Management, 11(4), 573–592. doi:10.2307/3324956.

    Article  CAS  PubMed  Google Scholar 

  22. Lazariu-Bauer, V., Stratton, H., Pruzek, R., & Woelfel, M. L. (2004). A comparative analysis of effects of early versus late prenatal WIC participation on birth weight: NYS, 1995. Maternal and Child Health Journal, 8(2), 77–86. doi:10.1023/B:MACI.0000025730.02966.62.

    Article  PubMed  Google Scholar 

  23. Buescher, P. A., & Horton, S. J. (2000). Prenatal WIC participation in relation to low birth weight and medicaid infant costs in North Carolina—a 1997 update. Raleigh, NC: Center for Health and Statistics, North Carolina Department of Health and Human Services.

    Google Scholar 

  24. Kendrick, J. S., Zahniser, S. C., Miller, N., Salas, N., Stine, J., Gargiullo, P. M., et al. (1995). Integrating smoking cessation into routine public prenatal care: the smoking cessation in pregnancy project. American Journal of Public Health, 85(2), 217–222. doi:10.2105/AJPH.85.2.217.

    Article  CAS  PubMed  Google Scholar 

  25. Secker-Walker, R. H., Solomon, L. J., Flynn, B. S., Skelly, J. M., Lepage, S. S., Goodwin, G. D., et al. (1995). Smoking relapse prevention counseling during prenatal and early postnatal care. American Journal of Preventive Medicine, 11(2), 86–93.

    CAS  PubMed  Google Scholar 

  26. Secker-Walker, R. H., Solomon, L. J., Flynn, B. S., Skelly, J. M., & Mead, P. B. (1998). Smoking relapse prevention during pregnancy. A trial of coordinated advice from physicians and individual counseling. American Journal of Preventive Medicine, 15(1), 25–31. doi:10.1016/S0749-3797(98)00029-4.

    Article  CAS  PubMed  Google Scholar 

  27. Windsor, R. A., Cutter, G., Morris, J., Reese, Y., Manzella, B., Bartlett, E. E., et al. (1985). The effectiveness of smoking cessation methods for smokers in public health maternity clinics: a randomized trial. American Journal of Public Health, 75(12), 1389–1392. doi:10.2105/AJPH.75.12.1389.

    Article  CAS  PubMed  Google Scholar 

  28. Pbert, L., Ockene, J. K., Zapka, J., Ma, Y., Goins, K. V., Oncken, C., et al. (2004). A community health center smoking-cessation intervention for pregnant and postpartum women. American Journal of Preventive Medicine, 26(5), 377–385. doi:10.1016/j.amepre.2004.02.010.

    Article  PubMed  Google Scholar 

  29. Floyd, R. L., Rimer, B. K., Giovino, G. A., Mullen, P. D., & Sullivan, S. E. (1993). A review of smoking in pregnancy: Effects on pregnancy outcomes and cessation efforts. Annual Review of Public Health, 14, 379–411. doi:10.1146/annurev.pu.14.050193.002115.

    Article  CAS  PubMed  Google Scholar 

  30. Melvin, C. L., Dolan-Mullen, P., Windsor, R. A., Whiteside, H. P., Jr, & Goldenberg, R. L. (2000). Recommended cessation counselling for pregnant women who smoke: a review of the evidence. Tobacco Control, 9(Suppl 3), III80–III84.

    PubMed  Google Scholar 

  31. General Accounting Office. (2001). WIC faces challenges in providing nutrition services. Washington, DC: U.S. General Accounting Office.

    Google Scholar 

  32. Fox, M. K., Hamilton, W., & Lin, B.-H. (2004). Effects of food assistance and nutrition programs on nutrition and health: Vol. 3, Literature review. Economic Research Service, USDA: Washington, DC.

    Google Scholar 

  33. Schramm, W. F. (1985). WIC prenatal participation and its relationship to newborn medicaid costs in Missouri: a cost/benefit analysis. American Journal of Public Health, 75(8), 851–857. doi:10.2105/AJPH.75.8.851.

    Article  CAS  PubMed  Google Scholar 

  34. Schramm, W. F. (1986). Prenatal participation in WIC related to medicaid costs for Missouri newborns: 1982 update. Public Health Reports, 101(6), 607–615.

    CAS  PubMed  Google Scholar 

  35. Stockbauer, J. (1987). WIC prenatal participation and its relation to pregnancy outcomes in Missouri: A second look. American Journal of Public Health, 77(7), 813–818. doi:10.2105/AJPH.77.7.813.

    Article  CAS  PubMed  Google Scholar 

  36. Stockbauer, J. W. (1986). Evaluation of the Missouri WIC program: Prenatal components. Journal of the American Dietetic Association, 86(1), 61–67.

    CAS  PubMed  Google Scholar 

  37. Hebel, J. R., Fox, N. L., & Sexton, M. (1988). Dose-response of birth weight to various measures of maternal smoking during pregnancy. Journal of Clinical Epidemiology, 41(5), 483–489. doi:10.1016/0895-4356(88)90050-9.

    Article  CAS  PubMed  Google Scholar 

  38. Alexander, G. R., Kogan, M., Martin, J., & Papiernik, E. (1998). What are the fetal growth patterns of singletons, twins, and triplets in the United States? Clinical Obstetrics and Gynecology, 41(1), 114–125. doi:10.1097/00003081-199803000-00017.

    Article  CAS  PubMed  Google Scholar 

  39. Levy, D. E., & Meara, E. (2006). The effect of the 1998 master settlement agreement on prenatal smoking. Journal of Health Economics, 25, 276–294. doi:10.1016/j.jhealeco.2005.07.006.

    Article  PubMed  Google Scholar 

  40. Heckman, J. (1997). Instrumental variables: A study of implicit behavioral assumptions used in making program evaluations. The Journal of Human Resources, 32(3), 441–462. doi:10.2307/146178.

    Article  Google Scholar 

  41. Wooldridge, J. M. (2001). Econometric analysis of cross section and panel data. Cambridge, MA: The MIT Press.

    Google Scholar 

  42. Quinn, V. P., Mullen, P. D., & Ershoff, D. H. (1991). Women who stop smoking spontaneously prior to prenatal care and predictors of relapse before delivery. Addictive Behaviors, 16(1–2), 29–40. doi:10.1016/0306-4603(91)90037-I.

    Article  CAS  PubMed  Google Scholar 

  43. Sexton, M., & Hebel, J. R. (1984). A clinical trial of change in maternal smoking and its effect on birth weight. Journal of the American Medical Association, 251(7), 911–915. doi:10.1001/jama.251.7.911.

    Article  CAS  PubMed  Google Scholar 

  44. Windsor, R. A., Lowe, J. B., Perkins, L. L., Smith-Yoder, D., Artz, L., Crawford, M., et al. (1993). Health education for pregnant smokers: Its behavioral impact and cost benefit. American Journal of Public Health, 83(2), 201–206. doi:10.2105/AJPH.83.2.201.

    Article  CAS  PubMed  Google Scholar 

  45. Fingerhut, L. A., Kleinman, J. C., & Kendrick, J. S. (1990). Smoking before, during, and after pregnancy. American Journal of Public Health, 80(5), 541–544. doi:10.2105/AJPH.80.5.541.

    Article  CAS  PubMed  Google Scholar 

  46. General Accounting Office. (1992). Early intervention: Federal investments like WIC can produce savings. Washington, DC: U.S. General Accounting Office.

    Google Scholar 

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Acknowledgments

The research was supported by a grant from the USDA Food and Nutrition Research Program to the National Bureau of Economic Research (# 59-5000-6-0102). We thank Karen Dalenius from the Centers for Disease Control and Prevention (CDC) for help with the PNSS file and special thanks to WIC Program administrators in various state offices. These include Najmul Chowdhury (North Carolina), Patrice Wolfla (Indiana), Nancy Hoffman (Missouri), Penny Roth (Illinois), and Lisa Armstrong (Virginia). We would also like to acknowledge input from John Karl Scholz at the University of Wisconsin, Elizabeth Frazao from the Economic Research Service and Jay Hirschman at the USDA Food and Nutrition Bureau. All opinions are those of the authors and do not represent those of the various state WIC programs, the CDC or the USDA.

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Authors and Affiliations

  1. Department of Economics (Alumnus), Graduate Center, City University of New York, 365 Fifth Avenue, 5th Floor, New York, NY, 10016, USA

    Cristina Yunzal-Butler

  2. Department of Economics & Finance, Baruch College, City University of New York & National Bureau of Economic Research, 365 Fifth Ave, 5th Floor, New York, NY, 10016, USA

    Ted Joyce

  3. Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, 1621 Eastchester Rd, Bronx, NY, 10461, USA

    Andrew D. Racine

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  1. Cristina Yunzal-Butler
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Correspondence to Cristina Yunzal-Butler.

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Yunzal-Butler, C., Joyce, T. & Racine, A.D. Maternal Smoking and the Timing of WIC Enrollment. Matern Child Health J 14, 318–331 (2010). https://doi.org/10.1007/s10995-009-0452-7

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