Examining the Association Between Maternal Smoking During Pregnancy and Child Behavior Problems Using Quality-Adjusted Life Years


Objectives Examining the association between maternal smoking and losses in childhood health-related quality of life due to behavior problems provides parents and policymakers another tool for the valuation of smoking cessation during pregnancy. Methods Using the National Longitudinal Survey of Youth 1979 Child and Young Adult data, this study retrospectively examined a cohort of 4114 women and 8668 children. In addition to questions focusing on maternal smoking and general demographics, each survey included the Behavior Problems Index (BPI), a 28-item questionnaire with six subscales measuring childhood behavior problems (antisocial behavior, anxiousness/depression, headstrongness, hyperactivity, immature dependency, and peer conflict/social withdrawal). Responses to the BPI, completed by mothers with children ages 4–14, were summarized on a QALY scale using published preference weights. Results Children whose mothers smoked during pregnancy experience additional QALY losses of 0.181, on average, per year due to increased behavior problems. Boys suffered larger QALY losses associated with maternal smoking (0.242) compared to girls (0.119; p value = .021), regardless of age. Moreover, heavier smoking during pregnancy (i.e., 1 or more packs/day) was associated with larger QALY losses (0.282; p-value < .001). Conclusions for Practice These findings illustrate the burden of maternal smoking during pregnancy on child health, namely behavioral problems. The losses in QALYs may be incorporated into economic evaluations for smoking cessation interventions during pregnancy. Future research will investigate how maternal smoking following childbirth is associated with child QALYs.

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Financial support for this research was provided by a grant from the National Institutes of Health, Department of Health and Human Services, through the National Cancer Institute (1R01CA160104). The funding agreements ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

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Correspondence to John D. Hartman.

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Hartman, J.D., Craig, B.M. Examining the Association Between Maternal Smoking During Pregnancy and Child Behavior Problems Using Quality-Adjusted Life Years. Matern Child Health J 22, 1780–1788 (2018). https://doi.org/10.1007/s10995-018-2577-z

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  • Maternal smoking
  • Behavior Problems Index
  • NLSY
  • National Longitudinal Survey of Youth