Tobacco Facts.

When a pregnant patient reveals she smokes, Dr. Roxane Rampersad tells her the long list of risks:

— Decreasing her baby’s oxygen supply.

— Increasing her chances of having a premature or low birth weight baby.

— Increasing the chances of her placenta sheering off her uterus.

— Her baby could be stillborn.

But too often, short doctor visits are not enough to end the dangerous addiction.

“We don’t have a lot of help,” said Rampersad, who works at Barnes-Jewish Hospital’s clinic for high-risk pregnancies. “We do this sort of on our own. We always ask about smoking, discuss why it’s important to quit, but we don’t have a lot of options for them.”

In Missouri, 25 percent of adults smoke — the third highest in the United States, according to a comparison released in April by the Centers for Disease Control and Prevention. The state’s smoking rate among pregnant women — 18 percent — is also among the worst. The rate soars even higher among the disadvantaged: 31 percent of pregnant women on Medicaid, the state and federal health care program for the poor, smoke.

That’s why the Missouri March of Dimes has made providing Medicaid coverage for tobacco cessation programs its newest focus after working to improve newborn screening tests.

“About 18 months ago, we’ve shifted our focus to smoking cessation because of Missouri’s horrible track record,” director Debbie Kersting said. “As far as the problem of premature babies, if there’s a silver bullet, it would be to stop smoking.”

A smoking cessation program can take many forms, from self-help booklets to weekly support group sessions. The more intense the therapy, the greater chance of long-term success. Therapy along with the consistent use of nicotine replacements such as patches, gums and nasal sprays or other FDA-approved medications can double a person’s chances of quitting, research shows, though they should be seen as a last resort among pregnant women.

The budget passed by the Missouri Legislature last month includes using $3 million to pay for smoking cessation programs for those on Medicaid, which would trigger another $5.2 million in federal funds. But it could still get the ax. Democratic Gov. Jay Nixon must make $350 million in cuts before signing the already lean budget, which takes effect July 1.

The total of $8.2 million in cessation funds would help 14,200 smokers quit through a mix of behavior therapy and medications depending on the individual needs, according to the Missouri Department of Social Services. Teens and pregnant women — which alone total about 11,400 — would get priority.

‘LET’S BE SMART’

The provision’s sponsor, Sen. Kurt Schaefer, R-Columbia, said the expenditure is a start in reducing Medicaid costs. State figures show Missouri spends about $512 million in Medicaid funds each year to treat smoking-related illnesses.

“When it comes to Medicaid, we have to pay for that no matter what,” Schaefer said. “For those Medicaid dollars we have to spend, let’s be smart about it.”

Tobacco use is the single leading preventable cause of disease, disability and death, according to the CDC. The list of complications is long with having a premature or low birth weight baby. Children born to mothers who smoke during pregnancy are also at increased risk for asthma, colic and obesity. Maternal smoking has been linked to sudden infant death syndrome.

According to federal estimates, smoking-attributable newborn health care costs for Medicaid total $738 per pregnant smoker.

The solution is clear, according to a state-by-sate comparison released recently by the CDC. The report found that states which banned smoking in public spaces, enacted high cigarette taxes, placed restrictions on cigarette advertising and publicly funded cessation programs made great strides in reducing smoking rates.

Missouri is one of only six states that doesn’t cover tobacco cessation programs for people on Medicaid. It lacks statewide smoke-free laws in workplaces, restaurants or bars; and its 17-cent tax per cigarette pack is the lowest in the country. In overall funding for tobacco control, the state ranks 49th.

States that invest heavily have seen cigarette sales drop more than twice as much as the nation as a whole, the CDC has found. As spending increased, smoking prevalence declined faster. California, which has had a comprehensive tobacco-control program in place the longest, has seen lung cancer rates decline four times faster than those in the national average. The state saved $86 billion in tobacco-related health care costs between 1989 and 2004.

In Illinois, 21 percent of adults smoke and 11 percent of women smoke during pregnancy. The state two years ago banned smoking in public places, has a 98-cent cigarette excise tax and provides medicaid coverage for nicotine replacements and medications but not counseling.

HARD TO QUIT

Medicaid recipient Janee Staples, 24, of St. Louis, was smoking about 10 cigarettes a day before she became pregnant. She had to quit her job at a nursing home, she said, because of the heavy lifting involved. Now 16 weeks into her pregnancy, she said she’s gone over two weeks without a cigarette but is struggling. Her boyfriend smokes and stress is a trigger.

Staples receives prenatal care at People’s Health Centers on Delmar Boulevard, where she also participates in monthly parenting classes. She wishes something similar was offered to help her with her addiction.

“There’s parenting classes but no classes to help you stop smoking cigarettes,” Staples said. “They just tell you it’s not good, but your mom can tell you that. People can tell you that until they are blue in the face, but that doesn’t mean it’s going to help you stop.”

Dr. Abbe Sudvarg is a family doctor at Family Care Health Centers, which serves primarily Medicaid patients at their two locations in St. Louis. Sudvarg said the pregnant women she sees are highly motivated to quit and are often successful with just the counseling they get from nurses during their prenatal appointments.

“But then they come in for their postpartum visit, and they are smoking,” Sudvarg said. “They never stopped wanting it … their only motivation was in terms of unborn child. It didn’t have to do with themselves and their own well-being.”

Assistance would greatly increase quit rates, research shows. Of daily smokers who try to quit unaided, 90 to 95 percent will relapse, according to U.S. Public Health Service clinical practice guidelines.

For now, Rampersad said she just tells her patients at the Barnes-Jewish clinic to set a reasonable quit date, avoid people who smoke and reduce stress.

“It would be really nice if the government takes this as something really important and set aside funding,” she said. “We could take that money and have resources for this parent. It obviously affects health care dollars … and it’s so modifiable.”

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