Higher cigarette taxes and other tobacco control efforts reduce smoking among pregnant women. Programs targeting pregnant women are highly cost effective.

Smoking rates among pregnant women are responsive to tax increases. One recent US study estimated that a 10% increase in price would reduce maternal smoking rates by 7%. This responsiveness was found even among population subgroups with the highest smoking rates. Another US study evaluated a cessation program for pregnant women consisting of several types of interventions (group counseling sessions, individual use of a cessation guide, clinic reinforcement, a buddy system, and provision of pamphlets) and compared it with a population-based tobacco control strategy. The study found that for each $1 in program costs, the benefits of the intervention measured as the number of low birth weight (LBW) infants prevented by smoking cessation were between $17.93 and $45.83. Another cost-benefit analysis of having all pregnant female smokers participate in a cessation program during pregnancy used the 1985-1986 Behavioral Risk Factor Surveillance System data. The program involved a 15-minute counseling session, the distribution of instructional material, and two follow-up telephone calls. Costs averted by a pregnant woman who quit smoking included the costs of hospitalizing a LBW baby minus the costs of hospitalizing a normal birth weight baby. The study estimated that, if implemented throughout the US, the program would prevent 5,876 LBW births at a cost of $4,000 per LBW birth prevented. For every $1 spent, the program would save $3.31 in the cost of caring for LBW infants in a neonatal intensive care unit. Factors associated with attempts to quit by pregnant women included Hispanic ethnicity, higher education, above-poverty income, and shorter duration of smoking; for all age groups of pregnant women studied, shorter duration of smoking is positively associated both with attempts and with successful quitting.

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