Smoking cessation counseling with pregnant and postpartum women: a survey of community health center providers

Abstract

Objectives. This study assessed providers' performance of smoking cessation counseling steps with low-income pregnant and postpartum women receiving care at community health centers.Methods. WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) program staff, obstetric clinicians, and pediatric clinicians at 6 community health centers were asked to complete surveys. Smoking intervention practices (performance), knowledge and attitudes, and organizational facilitators were measured. Factors associated with performance were explored with analysis of variance and regression analysis.Results. Performance scores differed significantly by clinic and provider type. Providers in obstetric clinics had the highest scores and those in pediatric clinics had the lowest scores. Nurse practitioners and nutritionists had higher scores than other providers. Clinic type, greater smoking-related knowledge, older age, and perception of smoking cessation as a priority were independently related to better counseling performance.Conclusions. Mean performance scores demonstrated room for improvement in all groups. Low scores for performance of steps beyond assessment and advice indicate a need for emphasis on the assistance and follow-up steps of national guidelines. Providers' own commitment to helping mothers stop smoking was important. (Am J

Physician counseling of pregnant women about active and secondhand smoking in Argentina

“…However, physicians infrequently discussed the harm of SHS. These observations are not unusual, as other studies have shown that most obstetricians and gynecologists reported identification of smoking status, but that the provision of smoking treatment was not consistent [28] [29]. Any training in smoking cessation was significantly associated with counseling about both active smoking and SHS exposure even though the amount of training was quite limited for half of the physicians.…”

“…This could reflect a lack of confidence in their own counseling skills since a number of studies have found that while physicians may advise pregnant women to stop smoking, the vast majority of them do not adopt a smoking cessation proactive attitude because they were particularly pessimistic that they could influence women's smoking behavior [28] [30] [31] [32]. This could also be due to a lack of knowledge of the major adverse effects of tobacco smoke on pregnancy, and thus their previous answers may reflect a “respondent” bias because participants tend to respond what they think they are expected to.…”

Effectiveness of Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Methods in Medicaid-Supported Prenatal Care

“…The complexity of intervention procedures and time per patient are enduring barriers to routine provider use (Davis, 1997; National Committee for Quality Assurance, 2009; Ockene & Zapka, 1997; Muramoto, Connoly, Strayer, et al, 2000; Orleans, Barker, Kaufman, et al, 2000; Zapka, Pbert, Stoddard, et al, 2000; Latts, Prochazka, Sala, et al, 2002; Ershoff, 2004). SCRIPT training methods were successfully implemented especially during years 1 and 2, using a science-practice partnership philosophy.…”

Examining the timing of changes in cigarette smoking upon learning of pregnancy

“…The date of the first prenatal care or WIC visit was collected from the maternal medical record. Attendance at a WIC visit was considered equivalent to attending a prenatal care visit because the smoking cessation counseling provided by WIC staff members is similar to that provided by prenatal care providers (Zapka et al, 2000). …”