Doctor Studies: Dispensing the Stop Smoking Message
Medical professionals are dedicated to helping people lead healthy lives. And pediatricians, OB/GYNs and nurse midwives are uniquely positioned to address the dangers of smoking with some of our most at-risk populations: pregnant women and youth.

Five recent studies were undertaken statewide to assess the perceptions of these medical professionals in terms of their use of smoking cessation protocols and nicotine replacement therapy (NRT). Funded by the Ohio Tobacco Prevention Foundation, the studies were conducted by James H. Price, PhD, MPH, and Timothy R. Jordan, PhD, members of the University of Toledo Department of Public Health, and Joseph A. Dake, PhD, MPH, faculty member in the Division of Health at Wayne State University, Detroit.

Three of the five studies involved practitioners who work with pregnant women. The other two targeted pediatricians. All data was collected via a 3-wave postal mailing using standard survey research protocol. The results are summarized below.

OB/GYNs and Midwives: Delivering Cessation Advice
Smoking during pregnancy is the most preventable cause of premature deaths and poor birth outcomes. Reducing maternal smoking has tremendous potential to improve health and to reduce health care costs. The 5A’s method – ask, advise, assess, assist, arrange – is considered best practice for clinical smoking cessation and has been adapted for use during pregnancy.

Study: OB/GYNs’ use of the 5A’s method of smoking cessation with pregnant smokers.

Results

• 98% asked their pregnant patients about smoking but fewer engaged in advising (66%), assessing (42%), assisting (29%) and arranging for follow-up or referrals (6%).
• Majority believed that two activities would result in smoking cessation in pregnant smokers: explaining the dangers of smoking (65%) and referring patients to smoking cessation programs (57%).
• 26% reported they were “slightly confident” or “not confident at all” in their ability to refer pregnant smokers to such programs.

Conclusion

• OB/GYNs face many competing demands for their time and energy. However, considering the health consequences of smoking while pregnant, it is essential that they facilitate the delivery of preventive care regarding smokers. Future research should explore ways to help OB/GYNs better use the 5A’s method.

Study: OB/GYNs’ use of nicotine replacement therapy with pregnant smokers.

Results

• 26% of respondents prescribed NRT to pregnant smokers; 32% perceived NRT as safe, yet only 14% perceived it as effective.
• Doctors were most likely to prescribe NRT if the patient requested it (44%) and showed a openness to quitting (37%).

Conclusion

• The majority of OB/GYNs did not prescribe NRT, possibly due to uncertainty of the effectiveness with pregnant smokers. This may be because few respondents received smoking cessation training in medical school or their residencies. More continuing medical education is needed regarding smoking cessation and the use of NRT.

Study: Nurse midwives’ perceptions and use of smoking cessation protocol.

Results

• Few nurse midwives perceived there were barriers to counseling pregnant patients who smoked.
• Of the 73% who asked their patients about smoking, 92% engaged in advising, 66% assessing, 35% assisting and 12% in arranging for follow-up or referrals.
• 74% believed NRT would be the activity most likely to reduce the number of pregnant smokers, yet only 26% were confident in their ability to prescribe/recommend NRT.

Conclusion

• The most common barriers cited by nurse midwives were a lack of time and not knowing were to send the pregnant smoker for treatment. The midwives most likely to use the 5A’s techniques perceived fewer barriers, had higher perceived efficacy and outcome expectations, and tended to be older nurse midwives.

pediatricians: talking to adolescents and parents

Every day, nearly 6,000 youths start cigarette smoking. Of adult daily smokers, 90% started in their youth. In Ohio, 26.6% of adults smoke and 11.8% of those households have children. Many pediatricians use the 5A’s method with adolescent smokers, and with their patients’ parents, as well.

Study: Pediatricians’ use of nicotine replacement therapy with adolescent smokers.

Results

• 44% of the respondents said they did not feel competent in helping adolescents quit smoking.
• While 48% perceived NRT to be safe for adolescent use, 53% weren’t confident in their ability to use NRT.
• Only 17% were currently prescribing NRT (action and maintenance stages), using transdermal patches (81%), nicotine gum (53%) or antidepressants (44%).

Conclusion

• Even though preliminary evidence suggests that NRT is safe to use with adolescents, fewer that half of the respondents perceived it to be safe, indicating a possible lack of awareness of current literature. The low level of perceived competence in helping adolescents quit may be due to inadequate training on the subject in medical school.

Study: Pediatricians and smoking cessation among their patients’ parents.

Results

• 80% of pediatricians regularly asked parents about their smoking status.
• A majority “always” or “usually” implement two of the 5A’s steps: asking about smoking status (56%) and advising parents to quit smoking (60%).
• One area where the pediatricians felt very confident (83%) was explaining how a parent’s smoking impacts the health of the child.

Conclusion

• Ohio pediatricians appear to use the 5A’s in a very limited fashion, primarily to ask parents about smoking status and to give a strong message urging parents to quit. To become better tobacco interventionists, they would require more training so they can assist parents in quitting smoking.

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