Above, data from three Upper Peninsula counties and the state of Michigan shows the rates of births to mothers who smoked during pregnancy between 2010 and 2014. Rates rose 18 percent statewide between 2008 and 2014, according to a Michigan League for Public Policy’s Kids Count report released today on maternal and child health. (Graph courtesy of datacenter.kidscount.org)

MARQUETTE — Everyone knows smoking is bad, but data shows that’s not enough to free people — including pregnant women — from the deadly addiction, which is the leading cause of preventable illness and death in the U.S. and worldwide, according to the Centers for Disease Control and Prevention.

A report released today reveals rates of expectant mothers who use tobacco grew by 18 percent in Michigan between 2008 and 2014, as statewide funding for cessation and prevention has dwindled.

The Michigan League for Public Policy’s Right Start: 2016 annual report on maternal and child health, which reviews eight indicators on maternal and child health from 2008 to 2014, also reveals the number of preterm births (less than 37 weeks gestation) increased significantly, with the rate going up by 20 percent statewide.

The report is released on the third Thursday of November, which is the American Cancer Society’s annual Great American Smokeout, when smokers are encouraged to quit smoking or make a plan to quit.

Alicia Guevara Warren, Kids Count in Michigan project director at the MLPP, said the findings might surprise some.

“I think that there are a number of people who are really startled by this number,” Guevara Warren said. “The fact that statewide we have more than one in five births to a mom who’s smoked during pregnancy seems kind of counter to what we know, because we’ve seen a number of campaigns around the impacts and effects of smoking, period, and also smoking during pregnancy, so it is I think shocking to know that that many people still are smoking. But we do know that it’s also very difficult for people to quit.”

The report shows rates of women smoking during pregnancy are much higher in rural, low-density populations. This is especially true in the Upper Peninsula, where the average rate in 2014 was 34.9 percent, compared to the state average of 21 percent, according to the report.

In Marquette County, the rate of 29.5 percent is lower than other U.P. counties, but significantly above the state average.

Local Public Health Director Dr. Terry Frankovich said local data from the 2015 Community Health Needs Assessment survey of the western U.P. showed 45 percent of people with less than a high school degree were smokers, compared to just 5 percent who had four or more years of college, and a similar trend follows income level.

“It’s a huge discrepancy,” Frankovich said. “So when we look at the role tobacco plays in almost all the things that cause chronic disease and death — in terms of the role it plays in heart disease, stroke and cancer, which are leading causes of death in this country — that burden is borne, that risk factor is disproportionately represented in people who are poorer and have less education.”

Risks associated with smoking during pregnancy are premature and low birth weight, higher chance of birth defects and miscarriage, as well as a higher incidence of Sudden Infant Death Syndrome among babies with mothers who smoke during and after pregnancy, Frankovich said.

Funding

Guevara Warren said from the numbers, one would think it’s 1986, not 2016. She added that reduced budget funding is a primary culprit.

“Funding and programming cuts clearly have consequences and the state urgently needs to reinvest in evidenced-based smoking prevention and cessation efforts for pregnant women,” she said.

In the 2017 budget, including state and federal funds (excluding Medicaid dollars), smoking prevention and cessation initiatives were funded at $3.78 million, which is down 34 percent from budget year 2008. Currently, there is $10,800 targeted to prenatal outreach, up $800 from the 2008 budget, according to the report.

Frankovich said funding for smoking cessation and prevention for pregnant women in the western U.P. and Marquette County is practically non-existent through local health departments.

Meanwhile, barriers like lower income, less access to healthcare and information, less help with cessation in terms of medication and counseling, as well as a culture of acceptance around the behavior of smoking are more prevalent, she added.

“It’s funny because some people will say everybody knows it’s not good to smoke, but we’ve been able to clearly show that when we were able do a lot of messaging and activity around smoking, rates declined, and in the absence of that, rates increased,” Frankovich said.

The report states the ratio of spending by tobacco companies on marketing to the state’s spending on tobacco prevention is 190 to 1. Meanwhile, annual healthcare costs directly caused by smoking are $4.59 billion in Michigan.

Based on recommendations by the CDC for minimal spending on prevention and cessation programs, Michigan ranks 44th in the country, according to the report. The American Lung Association gives Michigan an F grade for spending on smoking prevention and cessation.

The state also receives annual tobacco settlement dollars that are meant to go toward such programming, but in 2016, Michigan spent nearly a quarter of those funds to cover debt service, according to the report.

Guevara Warren said increasing funding is critical, but “it’s important when we look at expanding funding for these types of programs that we do take a look at what other states are doing and ensure that we’re really funding evidence-based programs that work.”

Solutions

The report recommends policy changes that boost efforts to reduce and prevent smoking, especially during pregnancy and among youth; as well as ensure strong implementation of e-cigarette and hookah regulations to reduce smoking amongst youth.

Frankovich said preventing youth from starting smoking is critical from both an economic and public health standpoint, emphasizing that prevention is the “best bang for your buck.”

“We know and tobacco companies know that if you can get someone to begin smoking before the age of 18, you are vastly more likely to get someone who’s a smoker for a lifetime,” Frankovich said. “That is in part because we know now that adolescent brains are more susceptible to nicotine addiction, and so it’s critically important to prevent youths from beginning to smoke.”

Frankovich is working with other groups to raise the legal age for smoking from 18 to 21 years old, she said, explaining this will get cigarettes out of high schools, where kids are most at risk.

Guevara Warren said women don’t start smoking because they’re pregnant, but rather they keep smoking because they can’t quit.

“I think that’s really important that people aren’t shamed,” Guevara Warren said, adding that women should get support, encouragement and information about how to quit.

Frankovich also said it’s not fair to blame smokers.

“Personally, I place this at the feet of tobacco companies, because they’re selling a highly addictive substance, so it’s impossible to blame people for becoming addicted to something that’s an addiction, an addictable substance,” Frankovich explained. “It’s very difficult for people to quit once they’ve begun, which is again why it’s important to help people never start.”

Services

Smoking is shown to cause many different cancers as well as chronic lung diseases such as emphysema and bronchitis, heart disease, pregnancy-related problems, and many other serious health problems.

For help quitting, smokers can call the Michigan Tobacco Quitline, through the Michigan Department of Community Health at 1-800-QUIT-NOW (784-8669).

The local Federally Qualified Health Center is the U.P. Health Plan, based in Marquette, which offers tobacco cessation counseling and medications available by prescription.

UPHP also has information and links to helpful sites such as the Michigan Department of Health and Human Services, the CDC, and Smokefree texting programs on its website, www.uphp.com/members/medicaid-michild/healthy-living-information/tobacco-cessation.

The Marquette County Health Department offers a variety of printed tobacco cessation information, including no smoking signs for businesses. The MCHD also serves as the regulating licensing agency for smoking complaints in Marquette County bars, restaurants and workplaces.

In addition to the full report, localized information can be found at www.mlpp.org/kids-count/michigan-2/2016-right-start.

The Kids Count in Michigan project is part of a broad national effort to improve conditions for children and their families. Funding is provided by the Annie E. Casey Foundation, the Detroit-based Skillman Foundation, Steelcase Foundation, Frey Foundation, Blue Cross Blue Shield of Michigan Foundation, United Way for Southeastern Michigan, DTE Energy Foundation, Ford Motor Company Fund, Battle Creek Community Foundation, Kalamazoo Community Foundation and John E. Fetzer Fund of the Kalamazoo Community Foundation.

The MLPP is a nonprofit policy institute focused on economic opportunity for all.

Mary Wardell can be reached at 906-228-2500, ext. 248. Her email address is mwardell@miningjournal.net.