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American Journal of Public Health logoLink to American Journal of Public Health
. 1992 Mar;82(3):383–390. doi: 10.2105/ajph.82.3.383

Estimation of the break-even point for smoking cessation programs in pregnancy.

M Shipp 1, M S Croughan-Minihane 1, D B Petitti 1, A E Washington 1
PMCID: PMC1694383  PMID: 1536354

Abstract

BACKGROUND. Successful programs to help pregnant women quit smoking have been developed and evaluated, but formal smoking cessation programs are not a part of care at most prenatal sites. The cost of such programs may be an issue. Considering the costs of adverse maternal and infant outcomes resulting from smoking, we estimated there would be an amount of money a prenatal program could invest in smoking cessation and still "break even" economically. METHODS. A model was developed and published data, along with 1989 hospital charge data, were used to arrive at a break-even point for smoking cessation programs in pregnancy. RESULTS. Using overall United States data, we arrived at a break-even cost of $32 per pregnant woman. When these data were varied to fit specific US populations, the break-even costs varied from $10 to $237, with the incidence of preterm low birth weight having the most impact on the cost. CONCLUSIONS. It may be advisable to invest greater amounts of money in a prenatal smoking cessation program for some populations. However, for every population there is an amount that can be invested while still breaking even.

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Selected References

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  1. Andrews J., McGarry J. M. A community study of smoking in pregnancy. J Obstet Gynaecol Br Commonw. 1972 Dec;79(12):1057–1073. doi: 10.1111/j.1471-0528.1972.tb11887.x. [DOI] [PubMed] [Google Scholar]
  2. Butler N. R., Goldstein H. Smoking in pregnancy and subsequent child development. Br Med J. 1973 Dec 8;4(5892):573–575. doi: 10.1136/bmj.4.5892.573. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dunn H. G., McBurney A. K., Ingram S., Hunter C. M. Maternal cigarette smoking during pregnancy and the child's subsequent development: I. Physical growth to the age of 6 1/2 years. Can J Public Health. 1976 Nov-Dec;67(6):499–505. [PubMed] [Google Scholar]
  4. Ershoff D. H., Aaronson N. K., Danaher B. G., Wasserman F. W. Behavioral, health, and cost outcomes of an HMO-based prenatal health education program. Public Health Rep. 1983 Nov-Dec;98(6):536–547. [PMC free article] [PubMed] [Google Scholar]
  5. Ershoff D. H., Mullen P. D., Quinn V. P. A randomized trial of a serialized self-help smoking cessation program for pregnant women in an HMO. Am J Public Health. 1989 Feb;79(2):182–187. doi: 10.2105/ajph.79.2.182. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ershoff D. H., Quinn V. P., Mullen P. D., Lairson D. R. Pregnancy and medical cost outcomes of a self-help prenatal smoking cessation program in a HMO. Public Health Rep. 1990 Jul-Aug;105(4):340–347. [PMC free article] [PubMed] [Google Scholar]
  7. Hinton A. E., Buckley G. Parental smoking and middle ear effusions in children. J Laryngol Otol. 1988 Nov;102(11):992–996. doi: 10.1017/s0022215100107091. [DOI] [PubMed] [Google Scholar]
  8. Kleinman J. C., Pierre M. B., Jr, Madans J. H., Land G. H., Schramm W. F. The effects of maternal smoking on fetal and infant mortality. Am J Epidemiol. 1988 Feb;127(2):274–282. doi: 10.1093/oxfordjournals.aje.a114803. [DOI] [PubMed] [Google Scholar]
  9. Kramer M. S. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65(5):663–737. [PMC free article] [PubMed] [Google Scholar]
  10. LOWE C. R. Effect of mothers' smoking habits on birth weight of their children. Br Med J. 1959 Oct 10;2(5153):673–676. doi: 10.1136/bmj.2.5153.673. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lubs M. L. Racial differences in maternal smoking effects on the newborn infant. Am J Obstet Gynecol. 1973 Jan 1;115(1):66–76. doi: 10.1016/0002-9378(73)90090-2. [DOI] [PubMed] [Google Scholar]
  12. MacArthur C., Newton J. R., Knox E. G. Effect of anti-smoking health education on infant size at birth: a randomized controlled trial. Br J Obstet Gynaecol. 1987 Apr;94(4):295–300. doi: 10.1111/j.1471-0528.1987.tb03094.x. [DOI] [PubMed] [Google Scholar]
  13. Malloy M. H., Kleinman J. C., Land G. H., Schramm W. F. The association of maternal smoking with age and cause of infant death. Am J Epidemiol. 1988 Jul;128(1):46–55. doi: 10.1093/oxfordjournals.aje.a114957. [DOI] [PubMed] [Google Scholar]
  14. Marcoux S., Brisson J., Fabia J. The effect of cigarette smoking on the risk of preeclampsia and gestational hypertension. Am J Epidemiol. 1989 Nov;130(5):950–957. doi: 10.1093/oxfordjournals.aje.a115427. [DOI] [PubMed] [Google Scholar]
  15. Marks J. S., Koplan J. P., Hogue C. J., Dalmat M. E. A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women. Am J Prev Med. 1990 Sep-Oct;6(5):282–289. [PubMed] [Google Scholar]
  16. McIntosh I. D. Smoking and pregnancy: attributable risks and public health implications. Can J Public Health. 1984 Mar-Apr;75(2):141–148. [PubMed] [Google Scholar]
  17. Meyer M. B., Jonas B. S., Tonascia J. A. Perinatal events associated with maternal smoking during pregnancy. Am J Epidemiol. 1976 May;103(5):464–476. doi: 10.1093/oxfordjournals.aje.a112248. [DOI] [PubMed] [Google Scholar]
  18. Ounsted M., Moar V. A., Scott A. Risk factors associated with small-for-dates and large-for-dates infants. Br J Obstet Gynaecol. 1985 Mar;92(3):226–232. doi: 10.1111/j.1471-0528.1985.tb01087.x. [DOI] [PubMed] [Google Scholar]
  19. Phibbs C. S., Williams R. L., Phibbs R. H. Newborn risk factors and costs of neonatal intensive care. Pediatrics. 1981 Sep;68(3):313–321. [PubMed] [Google Scholar]
  20. Reed B. D., Lutz L. J. Household smoking exposure--association with middle ear effusions. Fam Med. 1988 Nov-Dec;20(6):426–430. [PubMed] [Google Scholar]
  21. Rice D. P., Hodgson T. A., Sinsheimer P., Browner W., Kopstein A. N. The economic costs of the health effects of smoking, 1984. Milbank Q. 1986;64(4):489–547. [PubMed] [Google Scholar]
  22. SIMPSON W. J. A preliminary report on cigarette smoking and the incidence of prematurity. Am J Obstet Gynecol. 1957 Apr;73(4):807–815. [PubMed] [Google Scholar]
  23. Sexton M., Hebel J. R. A clinical trial of change in maternal smoking and its effect on birth weight. JAMA. 1984 Feb 17;251(7):911–915. [PubMed] [Google Scholar]
  24. Swank R. T., Becker D. M., Jackson C. A. The costs of employee smoking. A computer simulation of hospital nurses. Arch Intern Med. 1988 Feb;148(2):445–448. [PubMed] [Google Scholar]
  25. UNDERWOOD P., HESTER L. L., LAFFITTE T., Jr, GREGG K. V. THE RELATIONSHIP OF SMOKING TO THE OUTCOME OF PREGNANCY. Am J Obstet Gynecol. 1965 Jan 15;91:270–276. doi: 10.1016/0002-9378(65)90211-5. [DOI] [PubMed] [Google Scholar]
  26. Underwood P. B., Kesler K. F., O'Lane J. M., Callagan D. A. Parental smoking empirically related to pregnancy outcome. Obstet Gynecol. 1967 Jan;29(1):1–8. [PubMed] [Google Scholar]
  27. Windsor R. A., Cutter G., Morris J., Reese Y., Manzella B., Bartlett E. E., Samuelson C., Spanos D. The effectiveness of smoking cessation methods for smokers in public health maternity clinics: a randomized trial. Am J Public Health. 1985 Dec;75(12):1389–1392. doi: 10.2105/ajph.75.12.1389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Windsor R. A., Warner K. E., Cutter G. R. A cost-effectiveness analysis of self-help smoking cessation methods for pregnant women. Public Health Rep. 1988 Jan-Feb;103(1):83–88. [PMC free article] [PubMed] [Google Scholar]
  29. Ylikorkala O., Viinikka L., Lehtovirta P. Effect of nicotine on fetal prostacyclin and thromboxane in humans. Obstet Gynecol. 1985 Jul;66(1):102–105. [PubMed] [Google Scholar]

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