FAIRMONT — When Fairmont obstetrician Dr. Patrick Bonasso has a pregnant patient who smokes, he tries to convince her to quit.

“I see more women who smoke than don’t smoke,” said Bonasso, of WomanCare. “Unfortunately, I don’t see a lot of proof that they do. I’d say a minority of patients slow down, but few of them quit.”

The problem — which can result in low birth weight babies and infants born addicted to tobacco and prone to asthma and ear infections — can be found throughout West Virginia.

In fact, the state leads the country in the percentage of pregnant women who smoke, and at 27 percent, the figure is nearly three times the national average of 10.4 percent.

“Over the years, West Virginia has been No. 1 in this category, and we’re getting tired of it,” said Kathy Danberry, the tobacco cessation program manager for the state Division of Tobacco Prevention (www.wvdtp.org), part of the West Virginia Department of Health and Human Resources.

According to figures released by Danberry’s office, mothers who smoke during pregnancy are 18.5 percent more likely to give birth to a preterm baby and 63.2 percent more likely to have a child die within the first year of life than those who did not smoke.

Smoking during pregnancy also can lead to increased illnesses during childhood. Complicated births because of smoking account for $1.4 billion in medical costs annually.

Danberry’s office is targeting the population with a series of programs and advertisements. The task is a bit daunting. “The audience is so small,” Danberry said. “There are something like 1,000 smoking pregnant women a day in the state at any one time. So we’re trying to reach those people with these ads.

“It’s going to be tough, but we’re doing it for the next six months, until the end of June.”

Bruce Adkins, director of the Division of Tobacco Prevention, agreed that a variety of methods to get the message out is required.

“One thing we’ve noticed is that there is no silver bullet,” he said. “There is no particular program that is the absolute of everything.”

And even though pregnant women who smoke are the primary target, the message has to get out to a wide range of people.

“There need to be multiple programs, not only to educate women of childbearing ages but also families and friends and co-workers. You have to constantly ask if someone is a smoker and, ‘What can we do to help you quit?’ It’s one of the hardest addictions to break, if not the hardest.”

Plus, once a baby is born, all families should refrain from smoking in close proximity to the newborn.

“It’s just as important that family members around the infant not smoke around the child,” Adkins said. “The secondhand smoke is just as dangerous. So we are also targeting them.”

In an effort to figure out how to help women who smoke while pregnant, it helps to understand why someone would do that.

“It’s a cultural thing,” Adkins said. “In some areas of the country, they smoke more than men do. The prevalence is higher and more men are quitting than women.”

Plus, Adkins, who has worked in the health field prior to leading the Division of Tobacco Prevention, believes that some women continue to smoke because they think a low birth weight baby might make for an easier childbirth experience.

A patient has never said that directly to Bonasso, the ob/gyn noted. However, he noted, few of his patients who do smoke actually quit when they get pregnant.

“It’s frustrating,” he said. “I don’t say this to patients, but I want to say to them, ‘That’s the most selfish act you can do.’ Sometimes I feel that way. This baby didn’t choose to get conceived in this environment. You have that baby and you are smoking cigarettes with carbon monoxide and nicotine. It’s not a healthy environment.”

Currently, an ad appearing on television, developed by The Arnold Agency in Charleston, tells pregnant women that “the power to quit is inside you.” After the first of the year, billboards featuring the same message will go up all over the state.

“We also have a lot of materials printed, such as brochures and posters, and we will distribute those to different outlets, such as hospitals, the ob/gyn docs... just about anybody that wants the stuff, we’re going to give it to them,” Danberry said.

The division runs a variety of anti-smoking programs, including one aimed at children called RAZE and a Quitline that anyone can call.

“We’ve been very successful in West Virginia with our RAZE program, but youth prevalence is still too high,” Adkins said.

The Division of Tobacco Prevention did not receive additional funds for the campaign that targets pregnant women who smoke. In fact, Danberry said, the division has gone from receiving tobacco company settlement funds to being a line item in the state budget.

“We get funding from the CDC (Centers for Disease Control and Prevention) and funding from the Legislature,” Danberry said.

All together, Adkins said, funding for his office stands at about $7 million, one-fourth of what the CDC recommends the state to spend on anti-smoking efforts.

“West Virginia is a tough market to do media and education,” Adkins said. “We are in a rural area, so we have to buy five media markets to get commercials on the air. That’s expensive, and even by doing that, you can only reach around 90-92 percent. There are some areas, that no matter what you buy, some areas never see them.”

E-mail Mary Wade Burnside at mwburnside@timeswv.com.