Melissa Briggs, an unemployed, single mother of a 6-year-old son and four months pregnant, still goes through a pack of Doral Light 100s each day.
A week ago, Briggs, 29, of Inverness, got a call from the Citrus County Health Department. She agreed to take part in a program meant to help pregnant mothers kick the habit. Briggs wants to end her addiction. And she knows it may be the toughest thing she has ever done.
"I'm actually nervous about it because I'm not sure I'm going to succeed," she said. "I know it's not a good thing to be smoking while I'm pregnant."
Despite millions in federal and state dollars spent across Florida to pry cigarettes from the fingers of pregnant moms, data compiled by the state Department of Health indicate that efforts in Citrus, Hernando and Pasco counties have had a muted impact. On the North Suncoast, the percentage of pregnant mothers who smoke ranges between two and three times higher than the figure statewide.
In 2002, the last year for which the Department of Health has data, 24.5 percent of pregnant mothers in Hernando County reported smoking while pregnant, ranking it fifth highest in the state. In Citrus, the figure was 24.3 percent, ranking it sixth; in Pasco County, the figure was 18.6 percent, or 18th in the state.
There are 67 counties in Florida.
While Pasco has steadily improved since 1998, when the percentage of pregnant mothers who reported smoking was 23.45 percent, Hernando and Citrus have shown increases over the last several years.
The upward trend comes at the same time the statewide percentage of pregnant mothers who smoke, 8.6 percent in 2002, has decreased from 11.2 percent in 1998. The reduction in Florida mirrors national trends.
The health effects of smoking on an unborn baby are well documented. Smoking constricts blood vessels. It introduces toxins into the bloodstream, particularly carbon monoxide, that rob a fetus of the nutrients and oxygen it needs to develop.
Low birth weights, ectopic pregnancy, premature births, stillbirths and an increase in the likelihood of dying in the first year of life have all been linked to smoking while pregnant. New research suggests it may also play a role in mental retardation and birth defects such as cleft lip.
"Tobacco use is one of the most important things that we can change that causes poor birth outcomes," said Annette Phelps, director of the family health services division of the state Department of Health. "It's such a high-risk factor."
The data Phelps' department works with _ used in this story _ are taken from birth certificate records. All pregnant mothers in Florida are asked whether they smoke, and hospital staffers record their responses as part of compiling a birth record.
According to Phelps, research indicates that education and income level play a role in the problem. White women with less than a high school education are most likely to smoke while pregnant, she said, and the problem is widespread in rural areas.
In 2002, Dixie County in North Florida, for example, had the highest percentage of smoking moms at 28.8 percent.
Hispanic women are least likely to smoke while pregnant, which Phelps said helps explain why Miami-Dade County repeatedly boasts the lowest percentage figure in Florida. That county has the largest Hispanic population of any county in the state. In 2002, 1 percent of pregnant women reported smoking there.
"We would certainly love to have 1 percent like Miami-Dade," said Carol Cummins, community health nursing director for the Pasco County Health Department. "That would be wonderful."
While the problem has not gone unnoticed, Cummins said, she is unsure why so many pregnant mothers in Pasco smoke. She did say that funds to support a vigorous antismoking campaign are limited.
In Florida, the state's primary program for stopping pregnant women from smoking is called Healthy Start, which is administered through county health departments. Funding for the program, which offers an array of prenatal health services, has remained steady at $34-million since 1997, even as Florida's population has boomed.
"We continually try to do more with less," Cummins said.
Hernando County Social Services Department director Jean Rags also pointed to stretched resources as a factor that complicates efforts to reduce smoking during pregnancies.
"You have less dollars to do more with," Rags said. "How effective can you be? You just have more women . . . more babies being born."
Many of the women Rags sees in Hernando County have low-wage, service-sector jobs. Money is tight; housing at times inadequate. Such factors, she said, can make it doubly difficult for moms to quit.
"The low-income population," Rags said, "has many more stresses."
And as any drug abuse counselor can tell you, stress and addiction feed on one another.
"The nicotine is highly addictive," said Susan Littnan, a health educator with the Citrus County Health Department. "These gals are pretty much hooked and they are pregnant, so they are stressing."
It was Littnan who called Briggs, the Doral Light 100s smoker. Littnan's department had recorded the fact that Briggs smoked when she came in for her pregnancy test. The department then phoned her to recruit participants for a new program in Citrus called You Can Quit Smoking.
Briggs will be given hard candy, sugar-free gum, a toothbrush and toothpaste. She will be offered herbal tea to help kick the coffee and cigarette habit; lotion and nail polish to keep her hands busy.
And, of course, Briggs is free to call or visit Littnan's office when the need arises.
Briggs said she has a lot of turmoil in her life at the moment. She is single, a mom, pregnant, and has no job. Still, she said she is committed to quitting.
At Littnan's urging, she is choosing a date about two weeks from now that is to be her last day as a smoker. Between now and then, she plans to gradually cut back.
Briggs said she hopes to succeed because she knows it is important for her health and the health of her unborn baby. And her son wants her to quit, too. But she also knows that for every smoker who quits for good, pregnant or not, many more return to the habit.
"I think it will be the hardest thing I have tried to do," she said.
_ Will Van Sant covers Hernando County and can be reached at 754-6127. Send e-mail to vansantsptimes.com.
Hernando and Citrus counties had the fifth- and sixth-highest percentages of women in Florida who reported smoking during their pregnancies in 2002, the last year for which the state Department of Health has compiled figures. The county with the highest rate was Dixie, at 28.75 percent; the county with the lowest rate was Miami-Dade, at 1.04 percent.
State average 8.6%
Source: Florida Department of Health