Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Corrine Williams, Sc.D.

Committee Member

Linda Alexander, Ed.D.

Committee Member

Christina Studts, Ph.D.


Premature delivery is defined as a baby born before thirty-­‐seven completed weeks of pregnancy. Premature delivery can result in a longer hospital stay after delivery compared to babies born at full-­‐term.1 Babies born before 37 gestational weeks also have a greater potential for health problems such as acute respiratory, gastrointestinal, immunologic, central nervous system, hearing, and vision problems, as well as longer-­‐term motor, cognitive, visual, hearing, behavioral, social-­‐emotional, health, and growth problems.2 Premature births can impact at the individual level and at a societal level. “The birth of a preterm infant can bring considerable emotional and economic costs to families and have implications for public-­‐sector services, such as health insurance, educational, and other social support systems.”3 According to the U.S. Department of Health and Human Services, the estimated annual societal economic burden associated with preterm birth in the United States is over $25 billion dollars per year.1 According to preliminary data for 2012, around 12% of live births were preterm in the United States.4 Worldwide, fifteen million babies are born premature every year, and around one million die from preterm delivery related problems.5 Unfortunately, preterm deliveries are on the rise. According to Chang, there has been an increase in preterm births in almost all countries with reliable data in the last twenty years.5 Many organizations and reports, such as the March of Dimes and Healthy People 2020 have recognized this trend and are trying to reduce preterm deliveries by 5-­‐10% by 2020.6 3 One of the causes of preterm delivery most studied in the literature is the use of cigarettes by pregnant women. Smoking during pregnancy has been associated with multiple complications, including low birth weight, premature rupture of the membranes, placenta previa, placental abruption, and preterm birth.3, 7 Most of the previous research conducted has been on low birth weight and the association with smoking during pregnancy.3, 7 However, according to Shiono et al, women who smoke one or more packs a day increased their chances of delivering before 33 weeks gestation by 60%, and 4% of preterm (33-­‐36 weeks) and 9% of very preterm births (<32 weeks) were attributed to smoking.8 Overall, smokers in this study had a greater likelihood of having a preterm birth, and had around 24% greater risk of preterm birth than non-­‐smokers.8 While research has shown that smoking during pregnancy is problematic, a well-­‐defined health intervention or smoking cessation program for pregnant women supported by all obstetricians and gynecologists has not been conceived. The American College of Obstetricians and Gynecologists suggests the use of prenatal visits to assess adherence to the evidence-­‐based clinical practice guideline for smoking cessation, the 5 A's (Ask, Advice, Assess, Assist, and Arrange). 9 Other smoking cessation programs include the use of pharmacology, such as nicotine replacement therapy, counseling, or psychosocial interventions.10 Overall, findings from existing systematic reviews suggest that nicotine replacement therapy, behavioral and educational cessation strategies, and multicomponent interventions may be beneficial to women who smoke in pregnancy or the postpartum period, however; the effectiveness and the impact of these various strategies on smoking and 4 infant outcomes in pregnant women remain unclear.10 The focus of these interventions is complete cessation of cigarette usage, and there is little emphasis on cigarette reduction interventions. Harm Reduction theory in public health is the use “of practical strategies that reduce negative consequences of drug use and unsafe behaviors by incorporating a spectrum of strategies ranging from safer use to managed use to abstinence.”11 Harm Reduction’s intention is not to exclude abstinence as a final goal for individuals, but rather provides people with more realistic short-­‐term choices that are attainable. While one study examined the risk of pre-­‐term delivery associated with pregnant women who quit smoking by trimester, there is no research on the effects of reducing smoking through all three trimesters on pre-­‐term delivery.3 This study would expand on those findings to examine whether women who reduce the number of cigarettes they smoke during pregnancy have a lower risk of preterm birth. Findings from this study may be used to inform interventions with pregnant women to reduce their smoking intake during pregnancy, which could lead to lower preterm deliveries and reduce their own risk of smoking related diseases.

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