Doctors fail to help pregnant smokers kick the habit

  Obstetricians Fall Short in Helping Pregnant Women Quit Smoking

At least 90% of surveyed obstetrician-gynecologists in Alabama follow the first two steps in the National Cancer Institute’s (NCI) guidelines for treating pregnant women: asking if they smoke, and, if they do, advising them to quit.

But, according to a study printed in the March 2001 issue of the Southern Medical Journal (Vol.94, No. 3: 297-303), far fewer OB/GYNs follow the third and fourth steps of the institute’s recommendations: assist and arrange follow-up. Just 28% reported they assist patients in their efforts to quit smoking, and even fewer — 24% — follow up to reassess the woman’s smoking status or reinforce her success.

Prenatal care offers ample opportunities for obstetricians to encourage women to quit, write the authors. But nearly 20% of pregnant woman smoke, resulting in extreme public health consequences.

Intervening during pregnancy is particularly important because of tobacco’s dangers to fetus and mother, a condition called "fetal tobacco syndrome." Ill effects include decreased birth weight and overall retarded fetal growth, fetal and neonatal (the period of time just after birth) death, risk of maternal bleeding during pregnancy, and premature rupture of the membranes, among others.

Despite these risks to the fetus and the mother, and despite the fact that pregnancy provides an excellent opportunity to encourage a smoker to quit, the study found that only 12% of the Alabama physicians in the sample completely adhered to the "4-A" model recommended by the NCI: ask, advise, assist and arrange follow-up. The findings are similar to earlier studies in Rhode Island and New Jersey.

"The problem is important. And resolving the problem is important," says Michael Thun, MD, vice president, epidemiology and surveillance research for the American Cancer Society (ACS) in Atlanta.

Thun says that, increasingly, researchers are looking for reasons why physicians aren’t following preventive health recommendations. "I think asking about smoking and taking appropriate action should be part of prenatal care," he says. "And it’s probably not optimal to expect the woman who smokes to bring it up."

Study author Diane M. Grimley, PhD, assistant professor in the Department of Health Behavior at the University of Alabama at Birmingham, sent surveys in 1997-1998 to 354 obstetrician-gynecologists in Alabama. Of the responses, 130 were acceptable for inclusion in the study.

Physicians Lack Understanding of Smoking Cessation Strategies

"I think the study confirms there really is a problem out there… [as indicated by] the answers among the physicians who responded," says Thun. The solution, he says, will include overall health care reforms that emphasize prevention, education, reimbursement systems that pay physicians for the time preventive medicine requires, and opportunities for doctors to learn state-of-the-art approaches for helping patients lead healthier lives.

In the Alabama survey, 86% of the physicians said they had never been trained in smoking cessation techniques. Nor did they appreciate the power and influence they have, as shown in other smoking cessation studies, to increase quit rates. Three-quarters of the doctors reported that a "very" or "extremely" important factor in deciding against helping a patient was their perception that she was not motivated to quit. Nearly one doctor in four felt if a patient were still smoking at the end of the first trimester, she probably would not quit—and thus intervening would not be worthwhile.

No Overnight Results

"They don’t realize that behavior change is a process," says author Grimley, "that change doesn’t happen overnight, and that messages from their doctor can really help people become more motivated to make a commitment to quit."

Grimley considers it "disheartening" that 37% of the doctors not currently assisting pregnant women to quit and half of those not following up said they had no intention of changing their approach in the foreseeable future.

Ten percent of physicians expressed interest in continuing medical education classes on the subject and another 10% said in-office training would help. Most (49%) wanted self-help materials they could hand to patients or classes they could direct patients toward (30%).

The ACS is involved in two initiatives to address the need for resources. "Make Yours a Fresh Start Family" provides materials, following the NCI guidelines, which physicians can share with patients. Contact your local ACS office for information. Another program, being piloted in Texas, Vermont, Colorado and Oklahoma, is a toll-free quit line that smokers call for preparatory materials and one-on-one counseling services. Some states — such as California, Oregon and Washington — offer similar quit lines. For information, call the ACS at 1-800-ACS-2345.

"The purpose of the pilot is to see if we can deliver effective cessation intervention by phone," says Ron Todd, MS Ed, ACS director of tobacco control. "We’re testing the protocol, and it’s looking pretty good."

About the author:


http://www.cancer.org

More health information - More smoking information