Smoking during pregnancy in Wisconsin compared to the United States, 1997.

PURPOSE: The purpose of this study is to identify disparities in maternal smoking between Wisconsin and United States women and to determine differences that explain the higher percentage of pregnant women who smoke in Wisconsin compared to the United States. METHODS: 1997 Wisconsin and US birth certificate data were compared and stratified by age, education, and race/ethnicity. The relative risks (the risk of Wisconsin women smoking during pregnancy compared to US women smoking during pregnancy) were calculated by direct standardization to the 1997 US distribution for these characteristics. RESULTS: In 1997, 17.9% of Wisconsin women smoked during pregnancy, compared with 13.2% nationally (relative risk [RR] = 1.4; Wisconsin women were 40% more likely to smoke than US women). Age and education adjusted RRs among Wisconsin women aged 20 and older were 2.3 (American Indian), 2.8 (Hispanic), and 2.2 (non-Hispanic black), while the RR was 1.2 for non-Hispanic white mothers. Among women 20 and older, the crude RR for Wisconsin was 1.5; adjusting for age, education, and race/ethnicity only slightly decreased the RR to 1.4. CONCLUSIONS: The percentage of women who smoke during pregnancy in Wisconsin continues to be above the national rate and the Healthy People 2000 goal of 10% or less. Disparities with the US average are particularly great for minority women in Wisconsin. Adjusting for age, education and ethnicity does not explain Wisconsin's higher prenatal smoking rate.

Meeting the challenge of tobacco use within the Medicaid population.

The Wisconsin Medicaid Program, which purchases health care for Wisconsin's low income residents, has entered into a number of partnerships designed to systematically address tobacco use by Medicaid recipients. With the help of Wisconsin HMOs, a chart audit established an overall tobacco use prevalence of 45.7%, about double that of the general population. A direct survey of Medicaid recipients confirmed a rate of 45.0%. The chart audit also revealed a dramatic under-utilization of currently available Medicaid smoking cessation benefits. Plans are now being made to increase this utilization on a statewide basis. In addition, a partnership with the Wisconsin Women's Health Foundation and the Bureau of Family and Community Health Program within the Division of Public Health has resulted in a pilot project to address tobacco use by low income, pregnant women. Finally, a partnership with a specialized HMO serving those with disabilities and the Mental Health Association in Milwaukee County plans to address tobacco use by those with chronic and persistent mental illness.