SP: Julie: Pregnancy and Smoking
Goal:

To improve the learners' understanding of the negative effects of smoking on reproductive health in women and how to provide appropriate tobacco interventions for pregnant and potentially pregnant women.

: 1 hr

After completing this activity participants will be able to:

  • Use tobacco cessation counseling techniques that address the unique concerns of women who are pregnant or who will potentially become pregnant

  • Discuss the great importance of preventing or stopping tobacco use with pregnant patients and women patients of childbearing age due to negative health effects on both the mother and child before and after birth

  • Consider the negative effects of using drug therapy to assist with smoking cessation during pregnancy when deciding on the best tobacco cessation intervention

  • Use intensive tobacco counseling intervention techniques as an alternative to pharmacotherapy in pregnant women

  • Adapt tobacco interventions to racial, cultural, and ethnic differences in tobacco use when treating women patients


Professional Practice Gaps

Tobacco use is still fairly common; in the United States. Approximately 28.4% of persons aged 12 or older used a tobacco product in the last month in a 2008 survey (NSDUH, 2009). Tobacco is estimated to be responsible for 443,000 premature deaths annually (CDCP, 2008) and cause significant morbidity (Surgeon General, 2004).

The effectiveness of tobacco interventions by health care providers was evaluated in a review of the literature by the review panel for the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update (Fiore, et al., 2008). They found that medication and counseling are more effective for promoting tobacco cessation than no treatment and that intervention effectiveness increases with increased intervention intensity. The Clinical Practice Guideline (Fiore, et al., 2008), also provided evidence-based guidelines for clinicians on how to provide brief and more extensive interventions in tobacco use.

Despite the documented need for tobacco cessation and effectiveness of clinical interventions and availability of practice guidelines, many physicians still are not providing evidence-based tobacco interventions. A number of studies have found that screening for tobacco use and recommending cessation occurs as frequently as 75% of the time, other appropriate tobacco interventions are made by primary care physicians less frequently (Schnoll R et al, 2006; Braun et al, 2004; Jaen et al, 2001; Ellerbeck et al, 2001).

Training physicians in evidence-based, brief tobacco interventions in order to assure that all physicians know and are confident to provide tobacco interventions will help address this practice gap.

References
Centers for Disease Control and Prevention. Cigarette smoking among adults -- United States, 2007. Morbidity and Mortality Weekly Report. 2008; 57(45): 1221-1226.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Results from the 2009 National Survey on Drug Use and Health. Office of Applied Studies, NSDUH Series H-38A, HHS Publication No. SMA 10-4586 Findings, Rockville, MD. 2010. Available at: http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9ResultsP.pdf Accessed on: 2010-09-21.
Smoking cessation treatment by primary care physicians: An update and call for training. American Journal of Preventive Medicine. 2006; 31(3): 233-239.
Smoking-related attitudes and clinical practices of medical personnel in Minnesota. American Journal of Preventive Medicine. 2004; 27(4): 316-322.
Tailoring tobacco counseling to the competing demands in the clinical encounter. Journal of Family Practice. 2001; 50(10): .
US Dept of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Dept of Health and Human Services. 2004. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/executivesummary.pdf Accessed on: 2004-12-17.