Using Master Settlement Agreement Funds to Reduce Prenatal/Postpartum Smoking in North Carolina:

Abstract

he North Carolina Health and Wellness Trust Fund Commission (HWTF) was established by the North Carolina General Assembly in May 2000 to receive 25% of the state’s share of the Tobacco Master Settlement Agreement in order to address the health needs of vulnerable and underserved populations in North Carolina. The HWTF addresses its statutory mission by investing in programs and establishing partnerships that focus on critical health needs in four major areas: youth tobacco use, obesity, health disparities, and access to medications. Governed by an 18-member commission of health care experts drawn from a variety of professions, the HWTF has embarked on these four major initiatives, all designed to reduce the economic and human suffering from preventable diseases. To date, the Health and Wellness Trust Fund has awarded over 250 grants that build capacity in local communities to prevent and treat chronic health issues. These local grantees make up the infrastructure that has enabled each of the Health and Wellness Trust Fund’s preventive initiatives to reach its overall goals. To enhance the impact of local grant infrastructure and to have a more sustainable impact statewide, the HWTF also designs and implements mass media campaigns and works to effect policy change at the local and state levels. Independent evaluations of its grant programs are conducted on an ongoing basis to measure and increase the effectiveness of all these strategies. Although North Carolina’s infant mortality rate has decreased dramatically in recent years, it still remains well above the national average. In 2008 North Carolina ranked 44th in the nation with 8.2 deaths per 1,000 births compared to the national rate of 6.8 deaths per 1,000 births. 1 According to the State Center for Health Statistics, three of the top four causes of infant death in North Carolina are directly associated with either maternal smoking during pregnancy and/or infant exposure to tobacco smoke after birth. 2 Analysis of the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) found that 24.6% of women reported smoking before pregnancy, 13.8% during pregnancy, and 20.3% after pregnancy. And, of those who smoked before pregnancy and quit during pregnancy, roughly half began smoking again by the time they completed the PRAMS survey three to six months postpartum. 3 If it were possible to eliminate smoking entirely during pregnancy, the infant mortality rate for the state would drop an estimated 10% to 20%, with the most improvement coming in underserved and disadvantaged communities where women are more likely to smoke while pregnant. 4