Smoking Among Low‐Income, Pregnant Women: Prevalence Rates, Cessation Interventions, and Clinical Implications

Susan Albrecht is Assistant Dean for Academic Affairs, John Rosella is a Doctoral Student, and Thelma Patrick is Assistant Professor, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
Birth (Impact Factor: 2.93). 08/1994; 21(3):155 - 162. DOI: 10.1111/j.1523-536X.1994.tb00515.x

ABSTRACT Smoking has a significant effect on the major causes of death and disability among women, including coronary heart disease, stroke, cancer, and osteoporosis. When pregnant women smoke, it adversely affects not only them but also the health, development, and functioning of their unborn and young children. Of the general population of pregnant women, between 20 and 45 percent smoke. Furthermore, among low-income and less educated pregnant women, the increase in prevalence of postpartum smoking relapse rates, continued smoking, and initiation of smoking underlies the need for developing effective interventions for prevention and cessation. Although self-help, stop-smoking materials demonstrated success in several trials, interventions used in conjunction with these materials were brief with little follow-up, and did not address the need for continued intervention to help maintain abstinence or cessation after birth. This article reviews the smoking cessation trials that have assessed the effects of various interventions on cessation rates among low-income pregnant women, and describes future research needs for clinic-based smoking interventions for those women and the clinical implications for health professionals.

  • [Show abstract] [Hide abstract]
    ABSTRACT: In 1989, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) developed a research utilization program to integrate evidence into practice areas where there were large discrepancies between research evidence and clinical practice. The current program, renamed Research- Based Practice (RBP), uses translational research methods to build from evidence such as that in the Cochrane database and to create protocols for integration of research directly into clinical practice. This article describes the development of the sixth project (RBP6), in which an evidence-based protocol to address smoking in pregnancy was integrated into clinical practice. The protocol includes screening women using descriptive statements and integrates the 5 As (ask, advise, assess, assist, arrange) into prenatal and postpartum care at every visit. By integrating smoking cessation counseling into care, nurses may reduce the risk of low birth weight among pregnant women in both the United States and Canada.
    Journal of Obstetric Gynecologic & Neonatal Nursing 08/2003; 32(5):676 - 682. · 1.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the United States cigarette smoking accounts for 11 % of deaths of women. Approximately one of every four women smoke. Among pregnant women, 20–50% smoke, although prevalence rates vary depending upon income, age, and educational level. Spontaneous quit rates are highest among pregnant smokers. interventions have been used to assist pregnant women to stop smoking, and the use of a combination of methods has yielded the highest quit rates among pregnant women, but postpartum relapse rates provide a glimpse of the short-term benefit of these intense efforts. Smoking cessation interventions for pregnant women must be considered within the larger context of women's lives to promote permanent smoking cessation.
    Journal of Obstetric Gynecologic & Neonatal Nursing 07/2006; 26(4):477 - 484. · 1.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Smoking during pregnancy has been linked to a variety of adverse outcomes for both maternal and child health. Decades of studies have sought to increase cessation antepartum and reduce relapse postpartum. A number of effective interventions exist to significantly reduce smoking rates during pregnancy; however, less is known about how to prevent relapse in the postpartum period. This review investigates interventions to prevent relapse in the long-term postpartum period. We focus specifically on nonspontaneous quitters (individuals who quit smoking as a result of an external intervention) to reveal differences in long-term response to interventions for this population compared to spontaneous quitters. A systematic literature search yielded 32 relevant studies of pharmacological, behavioral, and incentives-based interventions. Results were compiled, analyzed, and compared in order to evaluate success factors in maintaining cessation postpartum. Though intervention groups showed consistently higher quit rates during pregnancy than control groups, none of the intervention types were effective at preventing relapse in the longer-term postpartum period. One study maintained significantly higher abstinence in the longer-term period postpartum using a mix of behavioral and incentives strategies. Additional research in this area is needed to identify optimal intervention strategies to reduce long-term postpartum relapse, particularly for nonspontaneous quitters.
    Maternal and Child Health Journal 06/2013; · 2.24 Impact Factor