Teen Smoking and Birth Outcomes

[Author Affiliation]Mary Beth Walker, Georgia State University, Andrew Young School of Policy Studies, P.O. Box 3992, Georgia State University, Atlanta, GA 30302-3992, USA; E-mail mbwalker@gsu.edu; corresponding authorErdal Tekin, Georgia State University, Andrew Young School of Policy Studies, P.O. Box 3992, Georgia State University, Atlanta, GA 30302-3992, USA; E-mail tekin@gsu.edu.Sally Wallace, Georgia State University, Andrew Young School of Policy Studies, P.O. Box 3992, Georgia State University, Atlanta, GA 30302-3992, USA; E-mail swallace@gsu.edu.[Acknowledgment]We would like to acknowledge the generous financial support of the UPS Foundation. We would also like to thank Georgia's Department of Human Resources for data access and Panupong Panudulkitti for his excellent research assistance.1. IntroductionThe Centers for Disease Control and Prevention (CDC) reports that the incidence of low birth weight births (infants weighing less than 2500 grams at birth) is on the rise, and that very young mothers (those 15 years old and under) are two to three times more likely to have a low birth weight baby than their counterparts aged 24-34 years. The incidence of low birth weight for all teens is 23% higher than for the population as a whole (CDC 2006a). A recent study by Chen et al. (2007) concludes that low birth weight and other adverse birth outcomes observed in teen pregnancies cannot be fully attributed to known risk factors, such as low socioeconomic status and inadequate prenatal care.Low birth weight is correlated with a number of adverse outcomes for children, including future health problems and poorer educational outcomes. Low birth weight infants account for large public health expenditures: studies show that more than one third of the total dollar amount spent in the United States on health care during the first year of life can be attributed to low birth weight, even though low birth weight infants account for fewer than 10% of all births in the United States (Lewitt et al. 1995).1The presence of a link between birth weight and smoking has long been accepted. In a 2001 report, the Surgeon General stated that "Infants born to women who smoke during pregnancy have a lower average birth weight and are more likely to be small for gestational age than infants born to women who do not smoke. Low birth weight is associated with increased risk for neonatal, perinatal, and infant morbidity and mortality. The longer the mother smokes during pregnancy, the greater the effect on the infant's birth weight" (CDC 2001). Multiple studies have shown that tobacco use during pregnancy is correlated with lower birth weights; see, for example, Evans and Ringel (1999), Abrevaya (2006), and Abrevaya and Dahl (2008). Shiono and Behrman (1995) report that smoking during pregnancy accounts for 20% of low birth weight births, making it the single most important modifiable risk factor for low birth weight in developed countries (Kramer 1987).We also observe that the incidence of teen smoking is relatively high: In 2004, 21.7% of all high school students reported smoking cigarettes, while the incidence of cigarette smoking among nonteens was 20.9%.2 Data from the state of Georgia (1994-2002) indicate that approximately 22.1% of nonblack teen mothers report that they smoked during their pregnancies; whereas, only 11.7% of nonblack older mothers report smoking (Table 1).Table 1 Birth Outcomes and Smoking Behavior (Table omitted. See article image.)Could the observed differences in birth weights for babies born to teen mothers and babies born to nonteens be attributable, at least in part, to differences in the effects of smoking on infant health for these two groups? The issue is complicated by several factors. First, there are the physiological effects of nicotine on the fetus; medical research indicates that nicotine itself is a neuroteratogen, affecting nervous system development (see Roy, Seidler, and Slotkin 1998; Slotkin 1998; Law et al. …