Impact of local- and state-level tobacco control policies on prenatal smoking and birth outcomes in the United States, 2005-2018.

Background: The 2009 US Tobacco Control Act resulted in locally led policies to curb tobacco use. However, racial/ethnic and educational disparities in prenatal smoking persist and little is known about the effects of local laws.

Methods: Using 2005-2018 National Center for Health Statistics county-level natality data on 39 089 766 singletons linked to state-level cigarette taxes and county-level tobacco 21 (T21) and smoke-free legislation, we conducted conditional mixed-process models to examine the effects of tobacco control policies on prenatal smoking, then on associated changes in birth outcomes. We included interactions between T21 laws and age, and between cigarette taxes, race/ethnicity, and education.

Results: Non-Hispanic White women with a high school degree or less had the highest levels of prenatal smoking (23.0%-35.4%) and were the most responsive to cigarette taxes. Among non-Hispanic White women with 0-11 and 12 years of education, a $1.00 tax increase reduced prenatal smoking by 5.06 (95% CI: 6.99-3.12) and 2.04 (3.19-0.89) percentage points and increased birth weight by 7.74 (4.64-10.83) and 3.12 (1.32-4.92) g, respectively. County-level coverage of T21 laws and smoke-free legislation were associated with small reductions in prenatal smoking only.

Conclusions: State-level cigarette taxes reduced educational disparities in prenatal smoking and improved birth outcomes among non-Hispanic White women.