Tobacco use is a problem for many Missouri residents, including those who aren’t born yet. In 2016, Missouri had a smoking-during-pregnancy rate of 15.3% according to the CDC, which was more than double the national average of 7.2%.

That figure has dropped in Missouri from 18.4% in 2006 to 13.7% in 2018, said Valerie Howard, the Tobacco Prevention and Control program manager for the Missouri Department of Health & Senior Services.

Boone County had a smoking-during-pregnancy rate of 9.19% in 2018, the fifth-lowest in the state.

The problem is more common in rural counties with higher poverty rates and fewer programs for people who want to quit. Dent County had the highest smoking-during-pregnancy rate at 31.35%, according to 2018 data from the Missouri Public Health Information Management System. This means pregnant women had smoked at least once during the last 30 days at the time of the survey. Dent County was followed by Wayne, Ripley, Reynolds and Montgomery counties, respectively.

Jennifer Watson, a registered nurse with Columbia/Boone County Public Health & Human Services, said she rarely encounters expectant mothers who say they need help quitting. When she does, she directs them to a department cessation program that focuses on changing behaviors.

“It’s about providing encouragement and support to these people, assisting them in developing better coping strategies,” Watson said.

The low number of pregnant women in Boone County seeking tobacco cessation resources could be a reflection of that 9.19% smoking rate. Another explanation might be that women are reluctant to seek help because it means admitting they’re doing something unhealthy to their babies.

Mothers who smoke are at risk of preterm delivery, which can lead to death, disease and disabilities for their babies, according to the CDC. Babies whose mothers smoked while pregnant are about three times more likely to die from Sudden Infant Death Syndrome than those whose mothers didn’t smoke. Additionally, smoking while pregnant weakens babies’ lungs, creating potential for future health problems.

Sarah Younger, a neonatologist at MU Health Care, said she encounters pregnant women who smoke almost daily. Still, she’s not sure how many expectant mothers actually smoke because she believes many are not honest about it with their health care providers.

The main reason they might withhold such information is likely because women know smoking is bad for them and their babies, Younger said.

“They don’t want to admit to that or feel like their doctor might lecture them or think badly of them,” Younger said. “I feel like a lot of them just don’t report it.”

Younger mostly works with pregnant women when they are close to delivering. As a result, it’s usually too late for her to help them quit before the baby develops fully.

MU Health Care obstetricians, however, do talk to moms about the dangers of smoking while pregnant and can refer them to resources or prescribe medication to help them quit.

Younger said she sees this problem across all socioeconomic groups. Although she does not have demographic data on her patients, the pregnant smokers she interacts with come from both rural and urban areas.

In 2017, 35.5% of pregnant women who smoked lived in rural regions and 19.9% lived in urban regions, according to a report from the Missouri Pregnancy Risk Assessment Monitoring System. More than a quarter of women who smoked cigarettes during pregnancy lived below the federal poverty level.

In Springfield, the city-county health department decided to implement more smoking cessation resources for pregnant women after a 2018 community assessment revealed that smoking during pregnancy was one of the top public health issues alongside mental health, said Jill Allen, a Greene County public health nurse and the Nest team leader for prenatal services.

As a result, the Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program was implemented that year. The health department’s Nest Partnership, a program that provides health services to pregnant women, offers home visits by registered nurses trained to help people quit smoking.

“In our area, there tends to be a lot of family history that gets repeated, as well as poverty,” Allen said. “My clients tend to start smoking at a very young age.”

The state health department offers similar tobacco cessation services for expectant mothers, including education on the dangers of tobacco use through Safe Kids Missouri, the Missouri Tobacco Quitline and more.

Still, there is more that can be done. Howard noted that $1 invested in a smoking cessation program results in $3 saved in neonatal intensive care costs.

“We’ve seen that in states where there’s been an increase in taxes for tobacco products, as well as smoke-free ordinances and smoke-free policies, that has decreased tobacco use,” Howard said. “We know what works. As far as Missouri goes, some of those (policies and laws) we don’t currently have in place, so that is a consideration.”

Younger said there are plenty of tobacco cessation resources in Missouri. Some women simply lack the motivation to seek help, and she is not sure what to do about that.

“Smoking during pregnancy can cause genetic changes in the baby’s body that will affect them for the rest of their life,” Younger said. “So it’s really important for moms to feel comfortable talking to their health care provider about it. We’re there to help them, not judge them.”

  • Public Health and Safety reporter, spring 2020 Studying magazine writing Reach me at, or in the newsroom at 882-5700.

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