Washington, D.C. – After 15 years of study, researchers have discovered a simple and effective way to help pregnant smokers quit – a move that could dramatically improve birth outcomes and maternal health and reduce medical spending. Prenatal care providers who practice this brief intervention can increase smoking cessation rates among their pregnant patients anywhere from 30 to 70 percent.
The promise of this smoking cessation strategy has prompted more than 30 public and private health care organizations to meet here this week. They are launching a national public health campaign to promote the intervention and make it a routine practice for providers who care for pregnant women.
“How to end smoking during pregnancy remains one of our most challenging public health problems but we now have a simple, proven method that works,” says Doris Barnette of the U.S. Public Health Service’s (PHS) Health Resources and Services Administration. “By having groups partner to promote wider use of this intervention, I am hopeful that we will achieve our goal of dramatically reducing smoking rates among pregnant women by the year 2010,” she says.
Nearly 13 percent of women giving birth in 1998 smoked during during pregnancy, according to the National Center for Health Statistics (NCHS). But among some groups of women, the percentage is much higher. According to the NCHS, 30.4 percent of non-Hispanic white women aged 18-19 years smoked during pregnancy in 1998; 48 percent of non-Hispanic white women aged 20 and above who did not graduate high school smoked while pregnant. The PHS has set a goal of reducing smoking rates among pregnant women to 2 percent by the year 2010.
To accomplish this goal, prenatal care providers should adopt a proven and effective five-step counseling intervention and provide it as a routine part of prenatal care. In 5-15 minutes, providers can follow five steps:
- Ask the patient about her smoking status;
- Advise them about the benefits of quitting if they smoke, and the effect of smoking and quitting on the woman and fetus;
- Assess the willingness of the patient to attempt to quit within 30 days;
- Assist them with ways to quit by providing pregnant-specific, self-help smoking materials, problem-solving and techniques for quitting, social support in the practice setting and assistance in arranging social support for the woman among family, friends and co-workers; and
- Arrange during follow-up visits to track the progress of the patients attempt to quit smoking.
This “5-A” approach is adapted from the PHS’s clinical practice guideline,
Treating Tobacco Use and Dependence, which was released earlier this year.
Adopting this intervention would dramatically increase cessation rates and require providers to add only a few steps to their current practice. In a recent American College of Obstetricians and Gynecologists (ACOG) survey, nearly all ob/gyns reported that they always ask about smoking during a patient’s first prenatal visit and advise their patients to stop smoking. But only 56 percent reported always discussing cessation strategies and slightly more than a third (35 percent) provided their patients with self-help quitting materials. Now that a proven intervention has been identified, providers will know how to take the next steps necessary to help pregnant patients quit smoking.
“I am encouraged by the proven effectiveness of this simple intervention. With its availability, ob/gyns will now have a new strategy to help pregnant women quit smoking,” says Sharon T. Phelan, MD, ob/gyn and chair of ACOG’s Advisory Group on Prenatal Smoking Cessation.
“We want to make sure that every pregnant woman is asked about her use of tobacco when she enters prenatal care, and if she is a smoker, to make sure that she receives effective treatment, ” says Cathy L. Melvin, Ph.D., who directs the Smoke Free Families National Dissemination Office at the University of North Carolina at Chapel Hill, and helped lead the research effort identifying this method.” Through this five-step program, we think we have an opportunity to keep infants healthy as well as improve women’s long-term health if they quit during pregnancy and beyond.”
The National Dissemination Office was created this year via a $1.2 million grant from the Robert Wood Johnson Foundation (RWJF). RWJF has been promoting efforts to encourage pregnant women to stop smoking since 1993. “Pregnancy and the period following provides a unique reachable moment to help women stop smoking,” says Tracy Orleans, Ph.D., Senior Scientist and Senior Program Officer at RWJF. “If we are going to bring smoking rates down among pregnant women, we have to deploy vigorous, widespread, and innovative efforts to reach that goal.”
The Smoke-Free Families National Dissemination Office is, with its partners, undertaking a broad program to increase the number of providers and systems that offer proven, evidence-based interventions to curb tobacco use in pregnancy. Their efforts include maintaining the science base necessary to support and enhance the intervention, developing programs and partnerships to build the capacity of health system to offer these interventions, and encouraging demand among consumers and providers.
Smoking is the most important modifiable cause of poor pregnancy outcome in the U.S. It accounts for 20 percent of low-birthweight deliveries, 8 percent of pre-term births, and 5 percent of perinatal deaths. Maternal smoking during pregnancy contributes to sudden infant death syndrome and may cause fetal brain and nervous system problems.
According to some estimates, elimination of smoking during pregnancy could lead to an 11 percent reduction in the incidence of low birthweight infants. The effect on health spending is significant. According to a 1998 RAND analysis, the cost of caring for a low-birthweight infant is nearly $60,000 in the first year of life.
“This is an unprecedented opportunity to affect one of the most intractable maternal and child health problems of our time,” says Melvin, adding that the rate of low birthweight infants in the U.S. today is about what it was nearly 30 years ago. In 1998, 7.6 percent of births were low birthweight, the same rate as in 1970. “Adopting this intervention could prevent many of these low birthweight births,” she says. In 1998, 12 percent of low birthweight births were linked to women who smoke, compared to 7.2 percent for non-smokers.
The 30 organizations joining forces to promote this intervention include the Agency for Healthcare Research and Quality, the American Association of Health Plans, ACOG, the Association of Maternal and Child Health Programs, the US Centers for Disease Control and Prevention, the Health Resources and Services Administration and the Robert Wood Johnson Foundation.
Descriptions of the intervention can be obtained from the Smoke-Free Families National Dissemination Office (919-843-7663), from ACOG
(202-863-2450) Copies of the June 2000 PHS Clinical Practice Guideline, Treating Tobacco Use and Dependence can be obtained from the US Surgeon General’s web page:
www.surgeongeneral.gov/tobacco/default.htm.
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