REDUCING SMOKING DURING PREGNANCY AND POSTPARTUM - PHYSICIANS ADVICE SUPPORTED BY INDIVIDUAL COUNSELING

Background Physicians' advice to help pregnant women quit smoking duri ng prenatal care has had mixed results. Training and prompting physici ans to provide consistent advice and referral to on-site support might improve cessation rates. Methods. Pregnant women who smoked were rand omly assigned to receive structured advice from their physician and re ferral to individual behavior change counseling during prenatal care o r to receive brief advice to stop smoking and a quit smoking booklet a t their first visit. Smoking status was measured by self-report, exhal ed carbon monoxide, and urinary cotinine. Results. Compared with usual care, greater proportions of intervention group women reported not sm oking at the 36th-week visit (14% vs 10%) and at 1 year postpartum (18 % vs 11%), but these differences were not significant. However, signif icantly greater proportions of intervention group women reported eithe r not smoking or reducing their cigarette consumption by 50% or more a t their second visit (43% vs 29%, P = 0.02), at their 36th-week visit (40% vs 25%, P < 0.01), and at 1 year postpartum (26% vs 14%, P = 0.02 ). Conclusions. Physician training on how to gain a pregnant smoker's commitment to change her smoking behavior, an office prompt system, an d individualized smoking behavior change counseling show promise in re ducing smoking during pregnancy and postpartum, but practical methods to assist pregnant smokers between regular prenatal visits, as they at tempt to quit, need to be developed. (C) 1998 American Health Foundati on and Academic Press.