The birth of health problems

Alexandria Campbell smoked cigarettes through all three of her pregnancies for one simple reason: It was too hard to stop.

The 26-year-old Spokane mother said she took a class to curb her nicotine addiction and asked her doctor for advice. In the end, the best she could do was trim her half-a-pack problem to four or five cigarettes a day.

“I cut down quite a bit with both of the girls,” Campbell said Tuesday, cradling 4-month-old McKinzie as Jaiyden, 18 months, napped in a stroller.

Her oldest child, Austin Burke, 8, lives with his father.

“I do want to stop, but I don’t,” said Campbell, adding that her children have shown no ill effects from her smoking. “It’s more of a habit.”

Mothers like Campbell are a worry for Spokane County health officials, who are struggling to lower a regional rate nearly twice as high as the state average.

Across Washington, about 10 percent of pregnant women smoked in 2005, according to statistics gleaned from state birth certificate surveys. In Spokane, the rate was nearly 19 percent. That translates to an estimated 1,040 babies born here each year to mothers who smoke.

“We are definitely aware that this is a problem,” said Jennifer Hansen, a public health educator with the Spokane Regional Health District’s Tobacco Prevention and Control Program. “We’re definitely not the worst, but we’re certainly not the best, either.”

Smoking during pregnancy can cause serious, even life-threatening, problems including low birth weights, respiratory difficulties and a five-fold increase in the chance of sudden infant death syndrome.

Across the state, smoking rates varied widely by county – from 2 to 36 percent – and partly because of mothers’ reluctance to admit smoking on a self-reported survey, said Tim Church, spokesman for the Washington Department of Health.

The figures are best used to track smoking trends, which indicate that cigarette use among pregnant women has declined in Washington by 30 percent since 2000, Church said. The state ranks 21st in the nation for smoking among pregnant women.

Still, there’s no question that Spokane ranks high, especially compared to more populous areas of the state. In King County, for instance, less than 5 percent of women smoke when pregnant, statistics showed.

Local health officials admit frankly that they’re puzzled about the reasons for the high rate – and what to do about it.

“We’ve been working with our assessment department here to figure out why our area here in Spokane is so unique,” Hansen said. “We’re going to do focus groups with pregnant women to find out.”

Part of the reason may be connected to general trends that show smoking is more prevalent among people with lower levels of income and education.

And part of the reason might be a spotty approach to tackling the problem. A March of Dimes grant two years ago aimed to stop smoking among 180 pregnant Spokane women, but when the funding ran out, so did the targeted classes.

Cessation programs are offered by CHER – the Community Health Education Resources program – but pregnant women are simply included with other smokers, said Emily Fleury, a health educator.

Spokane receives about $354,000 a year of the state’s $26 million in annual funds from a settlement with national tobacco companies, Church said. Local officials will use information from discussions with pregnant women to decide the best way to allocate the money.

It’s no secret what the women will say, said Maureen Shogun, a neonatal clinical nurse specialist at Deaconess Medical Center in Spokane. It’s her job to care for the babies born too tiny or too ill, often because of their mother’s smoking. But Shogun said she feels compassion for women caught between powerful pulls of maternal instinct and tobacco dependence.

“It is hard to quit,” she said. “Nicotine is a tremendously addictive agent.”

Even cutting back on cigarettes, as Alexandria Campbell did, makes a difference, Shogun said: “I always say that’s good, clean air the fetus is getting.”

She suggests reaching out to women when they’re pregnant with education and resources. Washington statistics show that more than half of women who stop smoking during pregnancy will quit for good.

“Many women won’t change for themselves,” said Shogun, “but they’ll make a valiant effort for their baby.”

Reach reporter JoNel Aleccia at (509) 459-5460 or by e-mail at jonela@spokesman.com