The smoking-attributable risk (SAR) for low birth weight infants of Medicaid patients in Alabama

The purpose of this research was (a) to document the smoking attributable risk for Medicaid-eligible patients in Alabama, (b) to determine if eliminating or significantly reducing tobacco exposure was associated with infant birth weight outcome results, and (c) to determine if race was a determinant of low birth weight. Quantitative measures were applied to determine if there were differences in birth weight outcome for smokers and nonsmokers. The study contributes to the smoking cessation literature by comparing cotinine validated smoking status and accurate birth weight outcomes for smokers versus nonsmokers.;The study sample consisted of 1,562 participants of the 4 phases of the Smoking Cessation or Reduction in Pregnancy Trial. Analyses revealed that the low birth weight rate in this sample was 8.8%, and the smoking attributable risk was 19.6%. Smokers were twice as likely to have low birth weight infants (Odd Ratio = 2.1, p = .003), and there was a statistically significant difference in the mean birth weight of smokers' infants when compared to nonsmokers' infants (p = .000). There was a statistically significant difference in the mean birth weight of no change smokers' infants when compared to infants of smokers who quit or reduced smoking during pregnancy, and significantly reducing smoking during pregnancy was significantly associated with having a higher birth weight outcome. White smokers had lower mean birth weight infants than White nonsmokers (p = .000), but there were no differences in the mean birth weight of Black smokers' and nonsmokers' infants (p = .211).;The results of the analyses support the conclusion that smoking during pregnancy affects the birth weights of infants, and significantly reducing smoking by lowering the amount of cotinine in the system or by reducing the number of cigarettes per day is necessary to increase birth weight outcome. Because smoking during pregnancy is detrimental to both the mother and the infant in any race, clinicians should promote smoking cessation in all women but place priority on other issues such as weight gain and hypertension to Black mothers.