Maternal smoking during pregnancy (SDP) is associated with a number of adverse birth outcomes. It is currently unknown how tobacco sales policies affect SDP. In this retrospective study, investigators examined SDP rates during fluctuations in tobacco retailer density (TRD) across 6 southeastern states in order to analyze the association between TRD and SDP. Investigators found that the SDP decreased overall during the study period, and that overall TRD increased during the study period. There were 2.7 more stores per 10,000 adults in counties with high TRD increase and 0.6 more stores per 10,000 adults in counties with lower TRD increase. Although there was an overall drop in SDP across the 6 state regions, counties with high TRD had a smaller change in SDP than counties with low TRD (-5.0% vs. -19.0%, p<0.001). The association between SDP change and high vs. low TRD was statistically significant across comparisons of counties with different rurality categories, socioeconomic status and/or social vulnerability categories, and tobacco-funding categories. A mixed-effects model showed that county-level TRD increase and socioeconomic vulnerability, and rurality had the largest effects on SDP decrease (t=2.81 p=0.005 for TRD increase, t=1.89, p=0.06 for socioeconomic vulnerability, and t=-2.69, p=-.007 for rurality). Overall, the results of this study suggest that increased TRD could impede the prevention of SDP. Of note, the states included in this study declined to adopt the Affordable Care Act Medicaid expansion in 2014, indicating that their low-income populations may have had limited access to smoking cessation and contraception programs; further studies are needed to generalize the results from this study to other regions.
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