Evaluating the effect of local smoking restrictions in West Virginia on birth outcomes and prenatal smoking

Smoking during pregnancy is a well-established risk factor for adverse birth outcomes, including low birthweight (LBW) (<2500g) and preterm births (<37 weeks gestation). Growing evidence, however, indicates that prenatal exposure to secondhand smoke (SHS) is also associated with an increased risk of LBW and possibly preterm births.

Regulations on smoking can potentially decrease prenatal exposure to SHS and decrease smoking rates among pregnant women. In recent years, municipalities, counties, and states across the U.S. have increasingly enacted smoke-free legislation. West Virginia, however, has no statewide smoking ban; smoking restrictions occur at the county level as set forth by local boards of health.

Several studies have analyzed comprehensive smoking bans on prenatal smoking and/or birth outcomes; none has done a comparative analysis of county level variations in smoking restrictions.

Using 1997-2009 census birth data for West Virginia, we analyze the impact of varying levels of local smoking restrictions on birth outcomes (LBW and preterm births) and prenatal smoking, while controlling for relevant maternal characteristics. Regression analyses using three levels of smoking restrictions (Comprehensive - includes restaurants and bars; Intermediate - includes restaurants but not bars; and Limited - excludes restaurants and bars) demonstrates that Limited smoking restrictions have a negative (“lowering”) effect on birthweight by 1.2 percent, while Comprehensive bans positively affect (“increase”) birthweight by 0.4 percent. In addition, quantile regression analyses of the effect of Limited restrictions on birthweight indicates that the negative effect is more pronounced for the first quartile in the birthweight distribution by 2.1 percent.