1. Vermont has one of the nation’s worst rates of smoking while pregnant.

In a 2018 report, the Centers for Disease Control and Prevention said 15.5 percent of Vermont women smoked during pregnancy. The only states with higher rates were West Virginia (25.1 percent), Kentucky (18.4 percent) and Montana (16.5 percent). Missouri rounded out the top five at 15.3 percent.

Vermont’s incidence of smoking while pregnant was more than double the national rate of 7.2 percent.

Demographics and socioeconomic factors play a role in smoking rates: For instance, the CDC found that younger and less-educated women were more likely to use tobacco during pregnancy. Officials say having a lower income and living in a rural area also are linked with an increased prevalence of smoking.

2. Smoking poses serious risks, both for the fetus and the mother.

The Vermont Department of Health says smoking during pregnancy can lead to miscarriage, premature birth, low birthweight and birth defects. Experts say learning and behavioral problems also are risks, as are longer-term health problems.

“The long and short of it is, it wreaks havoc on pregnancy,” said Stephen T. Higgins, Ph.D., director of the Vermont Center on Behavior and Health at University of Vermont Larner College of Medicine. “It increases the likelihood of really serious problems across the board, and they aren’t over when the baby is born. In fact, the exposed neonate is at increased risk for all kinds of problems. And the more we learn, the more we’re seeing that those problems extend into adulthood.”

Those risks decline for expectant mothers who stop smoking. For example, state officials found the same incidence of low birthweight (6 percent) among nonsmokers or women who quit by the end of the first trimester. But that jumped to 14 percent among those who continued to smoke.

And if smoking continues after birth, infants and children face a long list of secondhand smoke risks including asthma attacks, respiratory infections, ear infections and even sudden infant death syndrome, the CDC says.

3. Vermont officials are taking a multifaceted approach to reduce smoking during pregnancy.

The state’s 802Quits program includes phone-based support for pregnant women to “help them tailor their quit journey to meet their needs,” officials say. That free program includes a dedicated coach and up to 10 coaching sessions; gift cards for completing those sessions; and nicotine-replacement medications with a physician’s prescription.

Other initiatives include a Nurse Home Visiting program, which offers visits for low-income families during pregnancy and early childhood. In 2017, state officials say, all of the Nurse Home Visiting clients who smoked were referred for cessation assistance, and 36 percent of them had stopped smoking by their one-year follow-up visit.

That’s a big improvement over the low quit rates often associated with smoking during pregnancy. The Vermont Center on Behavior and Health has found cessation rates of less than 10 percent among women who received only basic, traditional stop-smoking assistance, such a referral to a hotline.

4. Training obstetricians is another strategy to reduce Vermont’s smoking rate.

State officials have hosted a SCRIPT program training for UVM Medical Center obstetric residents and fellows. The acronym stands for Smoking Cessation and Reduction in Pregnancy Treatment.

A similar initiative soon will spread to many more providers. The Health Department’s Maternal and Child Health Division and the state Tobacco Control Program will be launching a cessation training program for OB/GYN practices statewide.

The training “will focus on strategies of implementing a smoking cessation intervention for pregnant smokers within the context of prenatal care,” said Ilisa Stalberg, the Maternal and Child Health Division’s deputy director. The program’s goals include boosting OB/GYN practices’ ability to routinely screen for tobacco use and to conduct counseling sessions using an evidence-based framework.

5. Research shows that using financial incentives is an effective way to curb smoking while pregnant.

The Vermont Center on Behavior and Health has been a leader in showing that many more women quit when they’re offered financial rewards rather than relying solely on traditional smoking-cessation methods. The center’s studies have offered a chance to earn up to $1,100 if women abstained from the time they entered treatment through three months post-partum.

That work is ongoing. Higgins said a recent clinical trial showed that 38 percent of pregnant women stopped smoking when they were offered monetary benefits, versus a 9 percent quit rate for those who didn’t get those incentives.

Such findings have been echoed numerous times, worldwide. Higgins and Laura J. Solomon, Ph.D., a professor emerita at UVM, authored a 2016 review of multiple studies showing that “there is a growing and compelling body of evidence supporting the efficacy and cost-effectiveness of financial incentives for smoking cessation among pregnant women.”

Some may object to the idea of “paying” people to not use an addictive substance. But Higgins says that would be an “unscientific, crude description of what we’re doing.”

By providing financial rewards, Higgins said, “you’re trying to offer a rewarding experience for making a healthy choice that mimics and actually acts through the same brain processes as the consequences for the unhealthy choice.”

Higgins hopes to see Vermont adopt financial incentives statewide for pregnant smokers. And that may be starting to happen: The Health Department has launched a pilot program in Rutland that includes counseling and up to $1,115 in incentives, with a goal of helping 30 pregnant women quit smoking.

Stalberg said Higgins’ team “was very instrumental in the design and implementation of the Rutland pilot.” If it’s successful, the program could expand to other communities, officials said.

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