Completeness of ascertainment of prenatal smoking using birth certificates and confidential questionnaires: variations by maternal attributes and infant birth weight. PRAMS Working Group. Pregnancy Risk Assessment Monitoring System.

Birth certificate data frequently are used to monitor the prevalence of smoking during pregnancy. The authors used a two-sample capture-recapture method to estimate the completeness of ascertainment of prenatal smoking on birth certificates and on confidential questionnaires in six US states. Completeness of ascertainment was also examined according to maternal attributes and infant birth weight. The samples included white women who delivered a live infant between 1993 and 1995 in one of six states (Alabama, Alaska, Georgia, Maine, South Carolina, or West Virginia) and who responded to a questionnaire mailed to them 2-6 months postpartum as part of the Pregnancy Risk Assessment Monitoring System. State-specific sample sizes ranged from 2,647 to 4,795. The completeness of ascertainment ranged from 70.6% to 82.0% using birth certificates and from 86.2% to 90.3% using confidential questionnaires. In all six states, the birth certificates' completeness of ascertainment varied by maternal education and infant birth weight, and the questionnaires' completeness varied by maternal age. Both birth certificates and questionnaires underestimated the true extent of smoking during pregnancy among these white women. Differential reporting by birth weights recorded on birth certificates would result in an overestimated association between low birth weight and prenatal smoking.

Prenatal smoking in two consecutive pregnancies: Georgia, 1989-1992.

OBJECTIVE: To explore the patterns of prenatal smoking among women whose first and second pregnancies ended in live births. METHODS: We used population-based data to explore prenatal smoking among 14,732 white and 8968 black Georgia residents whose first and second pregnancies ended in live births during 1989-1992. Smoking status was obtained from birth certificates linked for individual mothers. Because of demographic differences, we analyzed white and black women separately. RESULTS: Approximately 15% (2253) of white women and 4% (318) of black women smoked during their first pregnancy. Of those smokers, 69% (1551) of white women and 58% (184) of black women also smoked during their second pregnancy. For both white and black nonsmokers during the first pregnancy, low education was the most significant predictor of smoking during the second pregnancy, after adjusting for consistency of the father's name on the birth certificate, prenatal care, birth interval, mother's county of residence, and birth outcome. CONCLUSIONS: The prevalence of smoking in this study may be low because of underreporting of prenatal smoking on birth certificates. The majority of women who smoked during their first pregnancy also smoked during their second, suggesting that these women exposed their first infant to tobacco smoke both in utero and after delivery. Practitioners should offer smoking cessation programs to women during, as well as after, pregnancy. Pediatricians should educate parents on the health risks to young children of exposure to environmental tobacco smoke and refer smoking parents to smoking cessation programs.

Trends in risk behaviors for HIV infection among U.S. high school students, 1989-1991.

The objective of this study was to examine trends in rates of self-reported HIV-related instruction and behaviors among high school students in the United States. Self-administered questionnaires were completed by three independent, multistage national probability samples of public and private school students in grades 9 through 12 who were surveyed in the spring of 1989, 1990, and 1991, respectively. Controlling for demographic characteristics, we used logistic regression to test for trends from 1989 to 1991. From 1989 to 1991, the proportion of students who had received HIV instruction in school significantly increased from 53.7% in 1989 to 83.3% in 1991. At the same time, the proportion of students engaging in selected sexual behaviors generally decreased. We found significant declines in the proportion of students who had engaged in sexual intercourse (58.5% in 1989 to 54.1% in 1991), had two or more sex partners during their lifetime (40.1% in 1989 to 35.2% in 1991), and had four or more lifetime sex partners (23.6% in 1989 to 18.7% in 1991). School-based HIV instruction, which is reaching greater numbers of U.S. students, may be contributing to the decline in reported risk behavior. However, because the current level of HIV-related behavior is still too high, risk-reduction efforts for adolescents should be maintained and strengthened.