# Presentation: 475350

## THE EFFECTS OF SMOKING ON EARLY CHILDHOOD OUTCOMES: A POPULATION BASED STUDY

- Haihong Li
- Xiaowen Yang
- P. V. Rao

- Michael B. Resnick
- Mario Ariet
- Jeffrey Roth

- Maternal Child Health and Education Research and Data Center
- University of Florida

## Background

- Prenatal smoking is known to cause adverse health and educational outcomes
- There is a need for large population-based studies to systematically access magnitude of risk
- Path analysis offers a way to study a chain of outcomes with causal effects in one direction

## Study Question

- What are the short term and long term impacts of smoking during pregnancy on children’s outcomes in kindergarten, adjusting for differences in family socio-demographic characteristics and mother’s health status at delivery?

## Data

- Linked records from Florida Department of Health (birth vital statistics), the Agency for Healthcare Administration and Department of Education.
- Study sample consisted of 220,347 children born in 1996 and 1997.

## Outcome Variables

- Newborn health problems (NHSI)
- Developmental delay or disability up to 3 years old (DDD)
- Placement in Preschool special education (PKCD)
- Placement in Exceptional student education in kindergarten (ESE)
- All 4 outcomes are binary.

## Explanatory Factors

- Medicaid eligibility
- Mother’s age
- Mother’s marital status
- Mother’s education
- Mother’s race
- Child’s sex

- Previous pregnancy failure
- Number of previous live births
- Plurality
- Pregnancy Health Status

## Statistical Methods

- Poisson regression models were fitted, one for each of the 4 outcomes.
- Earlier outcomes were included in the model as predictor variables.
-       SmokingNHSIDDDPKCDESE
- Direct, indirect, and total effects were estimated.

## Results

- Prenatal smoking was strongly associated with NHSI, as well as with ESE.
- Prenatal smoking adversely affected DDD and PKCD, but was not statistically significant, even after incorporating indirect effects.

## Raw rates of adverse outcomes

## Relative risks of smoking versus nonsmoking

|  | Newborn health problems | Developmental delay or disability | Preschool special education | Exceptional student education |
| --- | --- | --- | --- | --- |
| Direct effects | 1.22
(1.19, 1.26) | 1.00
(0.95, 1.05) | 1.00
(0.96, 1.04) | 1.09
(1.06, 1.12) |
| Indirect effects |  | 1.05
(1.05, 1.05) | 1.02
(1.02, 1.02) | 1.02
(1.02, 1.03) |
| Total effects | 1.22
(1.19, 1.26) | 1.05
(1.00, 1.11) | 1.02
(0.97, 1.06) | 1.11
(1.08, 1.15) |

## Conclusion

- Prenatal smoking increases the risk of Newborn Health Problems by 22%.
- Prenatal smoking does not appear to have a significant direct effect on DDD. But its indirect effect mediated through Newborn Health problem increases the risk of DDD by 5%.
- Prenatal smoking does not appear to have a significant direct effect on PKCD. But its indirect effect mediated through Newborn Health problem increases the risk of PKCD by 2%.
- Prenatal smoking increases the risk of ESE by 9%. Its indirect effect mediated through Newborn Health problem results in a further increase in the risk of ESE of 2%. Thus, the total effect of Prenatal smoking is to increase the risk of ESE by 11%.

## Public Health Implications

- Government agencies and community organizations should continue to promote pre-pregnancy and prenatal smoking cessation programs.

**Notes:**
Again, just guesses. As with your other presentation, you need to translate findings into policy implications for this audience

## Acknowledgments

- Office of Vital Statistics, Florida Department of Health
- Office of Medicaid Research and Policy, Florida Agency for Health Care Administration
- Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida
- Maternal Child Health and Education Research and Data Center, University of Florida

## hli@biostat.ufl.edu