Tennant, P. (2018). Low birth weight paradox: effect of smoking on infant death. Retrieved from [twitter.com/pwgtennant/status/1030896340891586560](https://twitter.com/pwgtennant/status/1030896340891586560) 

University of Michigan - Ann Arbor

Low Birth weight babies have a significantly higher mortality rate than others. The smoking mothers are more likely to have low birth weight babies than non-smoking mothers. Thus, people inferred that the child mortality rate should be higher among children of smoking mothers. However, the observation runs contrary to our expectation. Low birth weight babies of smoking mothers have a lower child mortality than low birth weight babies of non-smokers.

Although smoking may contribute to low weight and be harmful for babies, other causes like genetic abnormalities (birth defect) are much more harmful than smoking. Those underweight babies would weight normal if their mother were non-smoker. But they still have a lower mortality rate than babies who have more severe medical reasons that made them born underweight.

We can explain this paradox with a causal diagram.  In this case, birth weight is the collider, a variable which is a common effect of two other variables, smoking and U(other causes like birth defects). Conditioning on the collider will open a back-door path that goes smoking -> birth weight <-U(birth defects) -> Infant death. The collider bias is so large that even makes smoking seems beneficial. 


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