The Kaiser Permanente prenatal smoking-cessation trial: when more isn't better, what is enough?

INTRODUCTION: The effectiveness of low-cost smoking interventions targeted to pregnant women has been demonstrated, although few gains in absolute cessation rates have been reported in the past decade. Under conditions of typical clinical practice, this study examined whether outcomes achieved with brief counseling from prenatal care providers and a self-help booklet could be improved by adding more resource-intensive cognitive-behavioral programs. DESIGN: Randomized Clinical Trial. SETTING: A large-group-model managed care organization. PARTICIPANTS: 390 English-speaking women 18 years of age or older who self-reported to be active smokers at their initial prenatal appointment. INTERVENTION: Participants were randomized to one of three groups: (1) a self-help booklet tailored to smoking patterns, stage of change, and lifestyle of pregnant smokers; (2) the booklet plus access to a computerized telephone cessation program based on interactive voice response technology; or (3) the booklet plus proactive telephone counseling from nurse educators using motivational interviewing techniques and strategies. No attempt was made to change smoking-related usual care advice from prenatal providers. MAIN OUTCOME MEASURE: Biochemically confirmed abstinence measured by level of cotinine in urine samples obtained during a routine prenatal visit at approximately the 34th week of pregnancy. RESULTS: Twenty percent of participants were confirmed as abstinent with no significant differences found between intervention groups. Multivariate baseline predictors of cessation included number of cigarettes smoked per day, confidence in ability to quit, exposure to passive smoke, and educational level. No differential intervention effects were found within strata of these predictors or by baseline stage of readiness to change. Cessation rates among heavier smokers were strikingly low in all intervention groups. CONCLUSION: Neither a computerized telephone cessation program nor systematic provision of motivational counseling improved cessation rates over a tailored self-help booklet delivered within the context of brief advice from prenatal providers. Innovative strategies need to be developed to increase the effectiveness of existing prenatal smoking interventions. Special attention should be paid to the needs of heavier smokers.     

Assessing the Delivery of Cessation Services to Smokers in Urban,Safety-Net Clinics

Inequities in smoking behaviors continue to exist with higher rates among persons with limited formal education and for those living below the poverty level. This report describes the scope of tobacco cessation services delivered to low socio-economic status (SES) patients in several primary care medical offices, considered as “safety-net” sources of health care. Using a cross-sectional design, a random sample of records were reviewed for 922 smokers from 4 medical offices. The primary outcome variable was the delivery of smoking cessation services as documented in medical records; information on patient demographics and number of visits during the past 12 months was also abstracted. Smoking status was assessed during the last office visit for 65 % of smokers, 59 % were advised to quit, readiness to quit was assessed for 24 %, 2 % indicated a willingness to quit within the next 30 days and a quit date was established for 1 %. Among smokers not yet ready to quit, few were counseled on the “5 R’s” (Relevance, Risks, Rewards, Roadblocks, Repetition). These results expand our understanding of the unfortunately limited scope of cessation services delivered to persons seen in safety-net medical offices and call attention to the need to redouble efforts to more effectively address smoking cessation among diverse, low SES patients served by safety-net primary care clinics.     

Smoking cessation and long-term weight gain in the Framingham Heart Study: an application of the parametric g-formula for a continuous outcome

Weight gain after smoking cessation can lessen the health benefits of, and reduce the incentives for, quitting smoking. Randomized clinical trials of smoking cessation have estimated this weight gain only over short periods of follow-up. We provide an estimate of long-term post-cessation weight gain in the Framingham Heart Study, a prospective observational study. We identified 2001 smokers free of diabetes, cancer, and cardiovascular disease in 1952. Using the parametric g-formula we estimated mean weight in 1972 if all smokers had quit at baseline versus if all had continued smoking. Our estimates were adjusted for demographic, socio-economic, and clinical factors at baseline and during follow-up. The estimated mean weight (95 % CI) at 20 years if all smokers had quit smoking was 75.2 kg (73.5, 76.6), compared with 70.2 kg (68.7, 71.8) if they had smoked 20 cigarettes/day and 73.4 kg (71.9, 74.6) if they had smoked 5 cigarettes/day (i.e., an estimated mean weight gain of 5.1 kg (3.1, 6.6) and 1.8 kg (0.8, 2.8), respectively). Smokers who were overweight or obese at baseline had a greater post-cessation weight gain on average. Our estimates suggest that smoking cessation can result in increases in body weight over 20 years. While the benefits of smoking cessation outweigh the risks due to post-cessation weight gain, our results highlight the need for long-term weight management interventions in combination with smoking cessation.     

A randomized controlled trial of smoking cessation counseling after myocardial infarction

BACKGROUND: Smoking cessation after myocardial infarction (MI) has been associated with a 50% reduction in mortality but in-hospital smoking cessation interventions are rarely part of routine clinical practice. METHODS: One hundred cigarette smokers consecutively admitted during 1996 with MI were assigned to minimal care or to a hospital-based smoking cessation program. Intervention consisted of bedside cessation counseling followed by seven telephone calls over the 6 months following discharge. Primary outcomes were abstinence rates measured at 6 months and 1 year post-discharge. RESULTS: At follow-up, 43 and 34% of participants in minimal care and 67 and 55% of participants in intervention were abstinent at 6 and 12 months. respectively (P<0.05). Abstinence rates were calculated assuming that participants lost to attrition were smokers at follow-up. Intervention and self-efficacy were independent predictors of smoking status at follow-up. Low self-efficacy combined with no intervention resulted in a 93% relapse rate by 1 year (P<0.01). CONCLUSIONS: A hospital-based smoking cessation program consisting of inpatient counseling and telephone follow-up substantially increases smoking abstinence 1 year after discharge in patients post-MI. Patients with low self-efficacy are almost certain to relapse without intervention. Such smoking cessation programs should be part of the management of patients with MI.     

The feasibility of a proactive stepped care model for worksite smoking cessation

Worksite smoking cessation interventions have achieved some success, but until recently have only intervened on those smokers at a stage of readiness to volunteer to participate in cessation programs. The present study assesses whether a sustained, proactive smoking cessation program based on a stepped care model that targets all smoking employees in the worksite can actually be delivered. In one worksite in Seattle (N = 273), a worksite-wide survey with a 99.3% response rate identified 53 smokers; subsequent new-hires added an additional 14 smokers to the worksite. This study delivered increasingly intensive intervention to those smoking employees who failed to quit smoking during the study period of 1.5 years. Telephone contacts (every 3 months) provided motivational messages tailored to the smokers' stage of cessation. Subsequent more intensive steps included self-help manuals and referrals to formal programs. The intervention also used community organization strategies, such as employee guided worksite activities to complement the individual and stepped strategies. In the study period, 18% of the smokers quit smoking. Participation rates in activities were good and on average worksite smokers moved over one stage of change from baseline toward quitting smoking.     

A comprehensive smoking cessation program for the San Francisco Bay Area Latino community: Programa Latino Para Dejar de Fumar

Background. Prevalence of cigarette smoking among Latinos compared to whites is higher among men (30.9% versus 27.9%), but lower among women (16.3% versus 23.5%). More acculturated Latina women, however, smoke more. Compared to other smokers, Latinos report consuming about half the average number of cigarettes per day. Up to a quarter of Latino smokers of less than 10 cigarettes per day may be underreporting consumption. The association between smoking and depression has also been found in Latinos. Program Goals. The Programa Latino Para Dejar de Fumar (Programa) goals are: 1) to evaluate attitudinal, behavioral, and cultural differences between Latino and white smokers; 2) to integrate these findings into a comprehensive, culturally-appropriate smoking cessation intervention; and 3) to implement the intervention in a defined community in order to decrease cigarette smoking prevalence, increase behaviors that may lead smokers to quit, and promote a nonsmoking environment. Program Components. Heightened concern about health effects of smoking, the importance of social smoking, and the influence of the family on behavior are integrated in the Programa components: 1) the promotion of a full-color, Spanish-language, self-help, smoking cessation guide (Guia), distributed at no charge; 2) an anti-smoking, Spanish-language, electronic media campaign; 3) community involvement; 4) quit smoking contests; 5) smoking cessation, individual, telephone consultations (consultas); and 6) collaboration with health care personnel. Results. Effectiveness of the Programa is being evaluated by annual, cross-sectional, random digit dialing telephone surveys compared to two baseline surveys. After 19 months of intervention, the proportion who had heard of the Programa increased from 18.5% to 44.0%, and over one third of less acculturated smokers had the Guia. Future directions will emphasize smoking prevention among youth, prevention of relapse among quitters, and depression prevention.     

Feasibility and Acceptability of a Text Messaging Program for Smoking Cessation in Israel

Text messaging programs on mobile phones have been shown to promote smoking cessation. This study investigated whether a text-messaging program for smoking cessation, adapted from QuitNowTXT, is feasible in Israel and acceptable to Israeli smokers. Participants (N = 38) were given a baseline assessment, enrolled in the adapted text messaging program, and followed-up with at 2 weeks and 4 weeks after their quit date. The authors used an intent-to-treat analysis and found that 23.7% of participants reported having quit smoking at the 4-week follow-up. Participants sent an average of 12.9 text replies during the study period, and the majority reported reading most or all of the texts. However, 34.2% of participants had unsubscribed by the 4-week follow-up. Moderate levels of satisfaction were reported; more than half agreed that they would recommend the program. Suggestions for improvement included adding advice by an expert counselor, website support, and increased customization. Results indicate that a text messaging smoking cessation program developed by modifying the content of QuitNowTXT is feasible and could be acceptable to smokers in Israel. The experience adapting and pilot testing the program can serve as a model for using QuitNowTXT to develop and implement such programs in other countries.     

Latinos report less use of pharmaceutical aids when trying to quit smoking

BACKGROUND: Latino smokers are more likely than white non-Latino smokers to attempt cessation, but less likely to receive cessation advice from physicians or to use nicotine replacement therapy (NRT). Proposed underlying causes have included lighter smoking, lower financial status, and less healthcare access. This study assessed these factors as possible explanations for disparate rates of smoking-cessation support. METHODS: Data were analyzed from a random, population-level telephone survey of Colorado adults that interviewed 10,945 white non-Latino respondents and 1004 Latino respondents. For the current analysis, main outcome measures were receipt of physician advice to quit smoking, use of NRT, and use of bupropion or other anti-depressant for smoking cessation. RESULTS: Latino smokers reported higher prevalence of quit attempts (71.5% v 61.6%, p <0.01) but less physician advice to quit smoking (46.4% v 56.2%, p <0.05) and less use of NRT or an anti-depressant for cessation (10.6% v 24.8%, p <0.0001). Adjusted for potentially confounding factors, the odds ratio (OR) for less Latino use of cessation medications was substantial and significant (full model OR=0.31; 95% confidence interval, 0.17 to 0.57). The adjusted OR for physician cessation advice was not significant. CONCLUSIONS: Population-level differences in health status, smoking level, financial status, or healthcare access do not explain why Latino smokers less often use proven pharmaceutical aids to increase cessation. Further research is needed to understand these disparities, and greater effort is needed to deliver cessation support to Latino smokers seeking to quit.     

Increasing access to evidence-based smoking cessation treatment: effectiveness of a free nicotine patch program among Chinese immigrants

Pharmacotherapy substantially increases smoking cessation rates. However, programs to reduce barriers to this evidence-based treatment may not improve access among high risk immigrant non English speaking populations. This study estimates the effectiveness of a tailored free nicotine patch (NRT) program among Chinese American smokers living in New York City (NYC). Between July 2004 and May 2005 NRT was distributed to 375 smokers through two community-based organizations that serve the Asian American population in NYC. Participants completed an in person baseline survey and a 4-month follow-up telephone survey. Using an intention to treat analysis the abstinence rate at 4 months was 26.7% (100/375). Predictors of cessation included higher levels of self efficacy at baseline, not smoking while using the patch and concern about personal health risks. Distribution through easy to access, culturally competent local community organizations increased the reach of a free nicotine patch program and assisted smokers in quitting.     

Supporting Pregnant Aboriginal and Torres Strait Islander Women to Quit Smoking: Views of Antenatal Care Providers and Pregnant Indigenous Women

To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64 % of smokers and 91 % of providers; between 56 and 62 % of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85–90 % of providers. Rewards for quitting were considered helpful by 63 % of smokers and 56 % of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.     

Evaluation of the "Time to Quit" self-help smoking cessation program.

Public health and hospital nurses have widespread contact with smokers; an effective smoking cessation program administered by nurses has tremendous potential. This study evaluated: 1) the effectiveness of the self-help cessation program, "Time to Quit"/"Moi aussi, j'écrase" (TTQ), provided on a one-to-one basis; and 2) a smoking cessation training program for baccalaureate nursing students. Nursing students recruited 307 smokers who were randomly assigned to receive one of two interventions. Control smokers received a list of community smoking cessation resources and experimental subjects received this list plus TTQ. Smoking self-reports and cotinine levels were obtained at baseline, six weeks and nine months. More smokers receiving TTQ had reduced at six weeks post-intervention, while there were no differences in quit or reduction rates at the nine-month follow-up. Students were positive about learning the techniques and their knowledge scores were significantly higher than those of non-participating students.     

Tobacco Use and Interest in Smoking Cessation Among Latinos Attending Community Health Fairs

Health fairs are vital for reaching underserved Latinos providing access to health services including smoking cessation. The purpose of this study is to describe tobacco use and interest in smoking cessation among Latino smokers attending community health fairs. We surveyed 262 self-identified Latinos attending health fairs; we assessed smoking behavior and attitudes of 53 (20.2%) current smokers. Smokers were mostly uninsured (98.1%), male (54.7%), recent immigrants (96.2%) with limited English proficiency (60.4% spoke Spanish at home), and were mainly light (86.3%) and nondaily (58.7%) smokers. Although most participants attempted to quit smoking at least once in the past year, only 5.0% of current smokers reported ever using cessation medication and 94.3% were unaware of free-telephone counseling. The majority of smokers were ready to quit within 30 days and were interested in participating in cessation programs. Health fairs provide a unique opportunity to address smoking cessation among underserved Latinos with limited knowledge of access to, and use of effective cessation services.     

Is Some Provider Advice on Smoking Cessation Better Than No Advice? An Instrumental Variable Analysis of the 2001 National Health Interview Survey

RESEARCH OBJECTIVE: To estimate the effect of provider advice in routine clinical contacts on patient smoking cessation outcome. DATA SOURCE: The Sample Adult File from the 2001 National Health Interview Survey. We focus on adult patients who were either current smokers or quit during the last 12 months and had some contact with the health care providers or facilities they most often went to for acute or preventive care. STUDY DESIGN: We estimate a joint model of self-reported smoking cessation and ever receiving advice to quit during medical visits in the past 12 months. Because providers are more likely to advise heavier smokers and/or patients already diagnosed with smoking-related conditions, we use provider advice for diet/nutrition and for physical activity reported by the same patient as instrumental variables for smoking cessation advice to mitigate the selection bias. We conduct additional analyses to examine the robustness of our estimate against the various scenarios by which the exclusion restriction of the instrumental variables may fail. PRINCIPAL FINDINGS: Provider advice doubles the chances of success in (self-reported) smoking cessation by their patients. The probability of quitting by the end of the 12-month reference period increased from 6.9 to 14.7 percent, an effect that is of both statistical (p < .001) and clinical significance. CONCLUSIONS: Provider advice delivered in routine practice settings has a substantial effect on the success rate of smoking cessation among smoking patients. Providing advice consistently to all smoking patients, compared with routine care, is more effective than doubling the federal excise tax and, in the longer run, likely to outperform some of the other tobacco control policies such as banning smoking in private workplaces.     

History of lifetime smoking, smoking cessation and cognitive function in the elderly population

To examine potential associations of the history of lifetime smoking and smoking cessation with cognitive function in the elderly. In a population-based cohort study of older adults in Saarland, Germany, a detailed lifetime history of smoking was obtained using standardised questionnaires. Cognitive function was assessed with a validated telephone-based instrument (COGTEL) at the five-year follow-up in a subsample of n = 1,697 participants with a baseline age >65 years. Multiple linear regression models were employed to predict cognitive performance, adjusting for potential confounding factors. Ever-smokers with a higher cumulative dose of smoking in pack-years scored lower in the cognitive assessment than never-smokers, with the association being more pronounced in current smokers than in former smokers. In fully adjusted models, current smokers with 21–40 pack-years scored 4.06 points lower (95 % CI ?7.18 to ?0.94) than never-smokers. In former smokers, a longer time since smoking cessation was associated with higher scores in the cognitive test with reference to current smokers, even after adjustment for pack-years. Former smokers who had quit for more than 30 years scored 4.23 points higher (95 % CI 1.75 to 6.71) than current smokers. Dose–response-relationships of cognitive function with cumulative dose of smoking as well as with time since smoking cessation were substantiated by restricted cubic splines regression. Our results support suggestions that smokers are at an increased risk for cognitive impairment in older age; that the risk increases with duration and intensity of smoking, and subsides with time after smoking cessation.     

Prevalence,habits and personal attitudes towards smoking among health care professionals

Background

Tobacco use is the second major cause of morbidity and the 4th most common health risk factor in the world. Medical professionals have a critical role in the process of smoking cessation both as advisers and behavioural models for the citizens. The aim of this study was to investigate the prevalence of smoking among health care professionals, their smoking habits and personal attitudes toward smoking, role and the responsibility of health care professionals in the prevention of smoking.

Results

Out of the total number of examinees, 175 (35,1%) are active smokers, 29 (5,8%) are former smokers, and 295 (59,1%) are non-smokers. Nurses with secondary education disagree the most with the claim that passive smoking is more harmful to health (χ2 test, p = .008), also with the claim that the introduced Smoking Act is fair to smokers (χ2 test, p = .021). More nurses with secondary education disagree completely or partially that one should pay attention to smoking in the presence of non-smokers (χ2 test, p = .012).

Conclusion

Training programs for health care workers are needed to improve their ability in smoking cessation techniques to provide active support to their patients.

     

Comparing Computer-Tailored,Internet-Based Smoking Cessation Counseling Reports with Generic,Untailored Reports: A Randomized Trial

To assess and compare the impact on quit attempts of online computer-tailored smoking cessation counseling reports and untailored reports, we performed a randomized controlled trial on a smoking cessation website in 2007–2008. After answering a questionnaire, current and former smokers were randomly assigned to immediately receiving either an online, individually tailored counseling report or a personalized but untailored generic report. Participants were invited by e-mail to report any smoking in the previous 24 hours, 48 hours after baseline. We used an intention-to-treat analysis, where nonrespondents at follow-up were counted as smokers. There were 2,872 participants at baseline and 2,226 at follow-up (78%). At baseline, there were 76% of current smokers (mean = 18 cigarettes/day) and 24% of recent quitters (median = 7 days of abstinence). The same proportion of smokers in both study groups had made a 24-hour quit attempt at follow-up (12.1%, P = 1.0). In baseline recent quitters, lapse/relapse rates at follow-up were similar in both groups (tailored: 25.1%, untailored: 23.5%, P = 0.64). We conclude that untailored reports were as effective as tailored reports in the short term. Even though these particular computer-tailored reports were not more effective than untailored reports, meta-analyses show that computer-tailored documents are in general more effective than untailored ones.     

Effects of Incentive-Based Smoking Cessation Program for Pregnant Women on Birth Outcomes

Objectives Cigarette smoking during pregnancy is an important modifiable risk factor for poor birth outcomes. We evaluated whether participation in a statewide incentive-based smoking cessation program for pregnant women, the Baby & Me-Tobacco Free (BMTF) program, was associated with improved birth outcomes. Methods Linked program and birth certificate data from 866 pregnant smokers who participated in the BMTF program and 11,568 pregnant smokers who were eligible for but did not enroll in the program were analyzed. The BMTF program consisted of 4 prenatal smoking cessation counselling sessions, 12 postpartum follow-up visits, breath carbon monoxide measurements to monitor smoking status, and rewards of diaper vouchers for quitting smoking. Logistic regression models were used to examine the associations of program participation with infant low birth weight and preterm birth. Results Participants who completed 3–4 prenatal smoking cessation sessions had a significantly lower rate of low birth weight than non-participants (4.9 vs. 11.6 %). After adjustment for multiple potential confounders, the odds ratios for low birth weight were 0.51 (95 % confidence interval, 0.30–0.88) in those participants completing 3–4 sessions and 0.37 (95 % confidence interval, 0.17–0.79) in participants who quit smoking, as compared with non-participants. Although not statistically significant, a protective effect was also suggested for preterm birth. Conclusions We found for the first time that successful participation in the BMTF program, a unique incentive-based smoking cessation program for pregnant women implemented in community settings, was associated with significantly reduced odds of having a low birth weight infant.     

Smoking cessation attempts in relation to prior health care charges: the effect of antecedent smoking-related symptoms?

PURPOSE: We hypothesize that elevated charges among former smokers reflect differential cessation of sicker individuals. We ascertained the relationship between prior health care charges and time to smoking cessation. DESIGN: Prospective, observational study using panel survey data and administrative health plan records. SETTING: A large managed care organization in Minnesota. SUBJECTS: A stratified random sample of 8000 health plan members 40 years and older, yielding 611 current smokers at baseline. MEASURES: Smoking cessation measured via self-report survey. Health care charges, mortality, and disenrollment data derived from automated health plan databases. RESULTS: Among smoking adults without chronic disease diagnoses at baseline, a first attempt at quitting smoking was positively associated with the presence of any inpatient charges (relative risk [RR], 1.9; p < .05) or any emergency department or urgent care charges (RR, 1.4; p < .10). We also observed positive associations between total charges and ambulatory charges in the top textile (RR, 1.5 and 1.6, respectively; p < .05) with a first attempt at quitting smoking, further suggesting graded relationships. Among smoking adults with one or more of four chronic disease diagnoses at baseline, being in the top two tertiles of total charges or ambulatory care charges was predictive of a subsequent attempt at quitting smoking. CONCLUSIONS: Higher health care charges, particularly from ambulatory (primary care clinic) settings, predicted smoking cessation among both individuals with and without chronic diseases. These charges may be proxies for other factors, such as smoking-related symptoms or physician advice or messaging regarding smoking cessation.     

Tobacco use patterns and attitudes among teens being seen for routine primary care

PURPOSE: To describe the tobacco-related attitudes, behaviors, and needs of smoking and nonsmoking teens being seen for routine pediatric care and to identify predictors of tobacco use. DESIGN: Cross-sectional survey of adolescent primary care patients who completed self-administered questionnaires in medical office waiting rooms while waiting for routine care visits. SETTING: A group-practice HMO in the Pacific Northwest. SUBJECTS: A sample of 2526 teenagers, ages 14 to 17, who consented to receive health promotion interventions as a part of a randomized trial in seven pediatric and family practice offices. MEASURES: A 38-item questionnaire assessed tobacco use history, attitudes, quit attempts, and stage of acquisition or cessation along with gender, age, race/ethnicity, body mass index, educational plans, frequency of exercise, attempts to lose weight, and depressed mood. RESULTS: Sixty-seven percent of teens approached (2526 of 3747) consented to complete a questionnaire and receive tobacco- or diet-related interventions as a part of their medical visit. About 23% of teen patients reported smoking at least one cigarette in the last month, although only 14% described themselves as current "smokers." Most current smokers (84%) smoked at least 20 days in the last month. Logistic regression predictors of smoking included older age, Native American ethnicity, lower educational aspirations, lower body mass index, smoking among half or more friends, smokers at home, and a positive depression screen. Among ever-regular smokers, most were in the action (28%), preparation (21%), or contemplation (22%) readiness to quit smoking stages, and 77% of current smokers had made one or more serious quit attempts in the last year. CONCLUSIONS: Most teens in these medical facilities consented to receive tobacco and diet interventions, and most self-described current smokers were contemplating or preparing to quit. Medical visits provide attractive opportunities for tobacco intervention, but messages should be tailored based on the patient's tobacco status and stage of acquisition or cessation.     

Smoking in pregnancy: patient and provider risk reduction behavior.

OBJECTIVE: To describe the range of risk reduction behaviors among women who continue to smoke after learning of their pregnancy, including reduced tobacco use, eventual cessation, and sustained abstinence as well as the patient-reported smoking cessation-promoting behaviors of prenatal care providers. METHODS: This research is part of a larger prospective, community-based study conducted to assess the association between maternal stress and birth outcomes and infant health and development. Over a 2-year period, from February 2000 to November 2001, women receiving prenatal care at a consortium of public health centers in Philadelphia, Pennsylvania, were consecutively recruited (n = 1,451) completing interviews at their initial prenatal visit and again 3 to 4 months following their delivery. Smoking rates during pregnancy were determined from responses given during the first postpartum interview, at 3 to 4 months postpartum. RESULTS: Of the 1,451 women interviewed at 3 to 4 months postpartum, 24.9 percent indicated smoking during their pregnancy. Of these antenatal smokers, 89.0 percent reported reducing their cigarette consumption during pregnancy. However, only 25.4 percent attained abstinence during their pregnancy. Among women who achieved abstinence during their pregnancy, 21.7 percent were still not smoking at the time of the postpartum interview. Antenatal smokers reported that prenatal care providers asked about their smoking (90.6%) and advised about quitting (76.5%). However, only 27.9 percent were given referrals to smoking cessation programs. CONCLUSION: While cessation was achieved by only a quarter of antenatal smokers, almost 90 percent reduced their cigarette consumption. Prenatal care providers identified and provided cessation advice to the majority of women who were smoking but they did not follow through with material assistance in the form of referrals to smoking cessation programs.