In 2016, maternal smoking rates in both Missouri and Lafayette County were significantly higher than the national average. The National Center for Health Statistics (NCHS) reported 7.2 percent of women who gave birth in the United States smoked during pregnancy. However, the rate was 15.5 percent in Missouri and 21.3 percent in Lafayette County, according to Missouri Information for Community Assessment Maternal, Infant and Child Health (MICA).

By 2017 not much had changed. The Department of Health and Senior Services (DHSS) reported the rate of mothers who smoked during pregnancy was about 14 per 100 live births in Missouri, and about 20 per 100 live births in Lafayette County.

LCHD’s Maternal Child Health (MCH) Program is designed to combat tobacco use in Lafayette County. The overall goal of the program, funded by Title V Maternal and Child Health Services Block Grant, is to improve the health and well-being of mothers and children in the County. “The high maternal smoking rate is a priority health issue of ours,” said Breann Jensen, a health educator at LCHD. To address this issue, the program provides smoking cessation resources and tobacco education classes.

Recently, Jensen and Angel Jiovenale, a registered nurse at LCHD, hosted three tobacco education classes for new and pregnant mothers. The class had participants from across Lafayette County including mothers who smoked during pregnancy, and who allowed others to smoke around their children. The women who attended the class learned about the impact of tobacco use during pregnancy, the health risks of secondhand smoke, and how to limit secondhand smoke exposure.

Findings from the classes surprised Jensen and Jiovenale. Several participants said their prenatal care providers never asked them if they used tobacco products. Jensen and Jiovenale were also surprised to learn that some of the mothers were never educated about the health risks of secondhand smoke. Jensen said it’s important for health care providers to ask women if they use tobacco, and be specific about tobacco or smokeless tobacco use. Some individuals may not realize that smokeless tobacco and e-cigarettes are tobacco products. Jensen said it’s also important to ask if anyone in the household uses tobacco products so patients are informed about the health risks associated with secondhand smoke exposure.

The Centers for Disease Control and Prevention (CDC) says smoking during pregnancy increases the risk of health problems for developing babies, including preterm birth, low birth weight and birth defects. Additionally, e-cigarettes and other tobacco products containing nicotine are not safe to use during pregnancy. Health effects may include:

  • Mothers who smoke are more likely to deliver preterm. Preterm delivery is a leading cause of death, disability, and disease among newborns.
  • Mothers exposed to secondhand smoke while pregnant are more likely to have lower birth weight babies.
  • Babies whose mothers smoke while pregnant, and babies who are exposed to secondhand smoke after birth, are more likely to die from sudden infant death syndrome (SIDS) than babies who are not exposed to cigarette smoke.
  • Babies whose mothers smoke are about three times more likely to die from SIDS.
  • Babies whose mothers smoke while pregnant, or who are exposed to secondhand smoke after birth, have weaker lungs than other babies.

Jensen says tobacco cessation programs and nicotine replacement therapy can be effective in helping pregnant women quit. However, Missouri’s efforts to quell tobacco consumption have proven dismal over the years and do little to promote tobacco cessation. The Truth Initiative, which advocates for tobacco control policies, reports these facts about Missouri’s tobacco tax and prevention efforts:

  • Missouri ranks 51st for its $0.17 cigarette tax per pack (enacted in August 1993), compared with the national average of $1.73. (Connecticut and New York have the highest cigarette tax of $4.35.)
  • Missouri’s Tobacco Quitline only invests $0.48 per smoker, compared with the national average of $2.10.
  • Last year, Missouri received an estimated $260.6 million in tobacco settlement payments and taxes. Of this, the state only allocated $48,500 in state funds for tobacco prevention.

The state’s lack of tobacco prevention is both expensive and deadly. Campaign for Tobacco-Free Kids points out that Missouri spends $3.03 billion per year in smoking-related health care costs, and ultimately, 11,000 Missourians die every year due to smoking.

As for Lafayette County, LCHD continues to tackle tobacco use through programs like MCH and Tar Wars, a school-based tobacco prevention program sponsored by the American Academy of Family Physicians. Tar Wars aims to reduce the overall smoking rate in Lafayette County by educating fifth graders at every school in Lafayette County. Jensen says it’s important to teach the program before middle school because roughly seven percent of middle school students use tobacco products. The hour-long class consists of science experiments and simulations to demonstrate tar build up in the lungs, and how much it accumulates in a year. These exercises educate students about toxins in tobacco products and increased risks for chronic obstructive pulmonary disease (COPD) and emphysema, both smoking-related illnesses.

For more information, contact Breann Jensen or Angel Jiovenale at 660.259.4371.


This project is/was funded in part by the Missouri Department of Health and Senior Services Maternal and Child Health Services Contract # A0C19380185, and is/was supported by the Health Resources Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant # B04MC32553, Maternal and Child Health Services for $12,202,566, of which $0 is from non-governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.