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Obstetrics & Gynecology 2007;110:765-770
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL ARTICLES

Best Practice Smoking Cessation Intervention and Resource Needs of Prenatal Care Providers

Katherine E. Hartmann, MD, PhD1,2,3, Mary E. Wechter, MD, MPH1,2,3, Patricia Payne, CNM, MPH4, Kathryn Salisbury1,6, Renee D. Jackson, MHA5 and Cathy L. Melvin, PhD, MPH6

From the 1Center for Women's Health Research, University of North Carolina, Chapel Hill; 2Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill; 3Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill; 4Family & Community Nursing Program, East Carolina University, Greenville; 5Women's and Children's Health Section, North Carolina Division of Public Health, Raleigh; and 6Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.

ABSTRACT

OBJECTIVE: To describe smoking cessation interventions by prenatal care providers and to identify factors associated with best practice.

METHODS: A mailed survey assessed implementation of the "5 A's" of best practice (Ask about smoking; Advise patients to quit; Assess willingness to quit; Assist with a cessation plan; and Arrange follow-up), practice characteristics, intervention training, resources, barriers, and attitudes toward reimbursement. Each factor in association with provider type and best practice implementation was analyzed.

RESULTS: Of 1,138 eligible North Carolina health professionals, 844 responded (74%); 549 were providing prenatal care and returned completed surveys. Most asked about smoking (98%) and advised cessation (100%). Across provider type, one third (31%) consistently implemented all "5 A's" of best practice. Most providers (90%) had at least one material resource (eg, pamphlets), which correlated with nearly 10 times the adjusted odds of best practice (odds ratio [OR] 9.6, 95% confidence interval [CI] 1.3–72.9). Seventy percent had at least one counseling resource. Having a counseling resource (OR 2.5, 95% CI 1.4–4.4) and a written protocol to identify staff responsibilities (OR 2.5, 95% CI 1.5–4.3) were equally associated with best practice. More than one half of providers endorsed reimbursement as influential on best practice.

CONCLUSION: Best practice is well-established to promote prenatal smoking cessation yet implemented by only one third of prenatal care providers in North Carolina. In this study, best practice was associated with resources, practice organization, and reimbursement. Augmented use of available resources (eg, toll-free hotlines) and adequate reimbursement may promote best practice implementation.

LEVEL OF EVIDENCE: III






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