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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 highly responsive to tax increases. For example, a 10% increase in price would reduce maternal smoking rates by 7% in the US. A 1% drop in the smoking prevalence rate among pregnant women in the United states would save $21 million in annual direct medical costs and prevent 1300 low weight births. 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) was found to be very cost-effective. A US$1 investment into the program prevented a birth of low weight infant for US$17.93 - $45.83.

A meta-analysis of smoking cessation and relapse among pregnant women participating in a cessation program confirmed that these programs see rapid returns on investment.

Among pregnant women behavioral counseling in tandem with another cessation strategy, increases quitting and prevents relapse. The cost-effectiveness of preventing relapse was $851 per life-year saved and $628 per quality-adjusted life-year saved compared to the usual care.



Ringel JS, Evans WN. Cigarette taxes and smoking during pregnancy. Am J Public Health. 2001; 91: 1851-1856.

Windsor RA, Lowe JB, Perkins LL, Smith-Yoder D, Artz L, Crawford M, Amburgy K, Boyd NR Jr
. Health education for pregnant smokers: its behavioral impact and cost benefit. Am J Public Health. 1993; 83(2): 201-206.

Ruger JP, Emmons KM. Economic evaluations of smoking cessation and relapse prevention programs for pregnant women: a systematic review. Value Health. 2008; 11(2): 180-190.

Ruger JP, Weinstein MC, Hammond SK, Kearney MH, Emmons KM. Cost-effectiveness
of motivational interviewing for smoking cessation and relapse prevention among low-income pregnant women: a randomized controlled trial. Value Health. 2008; 11(2): 191-198.

Chamberlain C, O'Mara-Eves A, Oliver S, Caird JR, Perlen SM, Eades SJ, Thomas J. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2013; 10: CD001055.pub4.

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