Physician smoking cessation advice and assistance in quitting have been successful preventive health services, and are still needed. Approximately 40% of pregnant women are exposed to tobacco smoke during pregnancy through either active or passive smoking. Low birthweight, preterm birth, stillbirth, and sudden infant death syndrome are among the most prominent effects of maternal smoking and secondhand smoke exposure during pregnancy. These consequences are in addition to the additional risks of smoking;active smoking in women alone caused 2.1 million lost years of life during each year in the 1990s. Pregnancy is an opportune time for interventions to help women to quit smoking, because a greater proportion of women quit smoking during pregnancy than at any other point in their lives. A vital component of tobacco education and counseling in the U.S. is the physician, and physician counseling is effective in increasing quit rates and decreasing secondhand smoke exposure. For these reasons, the U.S. Public Health Service (PHS), the U.S. Preventive Services Task Force (USPSTF) and the American College of Obstetrics and Gynecology (ACOG) recommend that physicians counsel all patients about tobacco use. However, many physicians do not assess smoking or counsel pregnant patients about tobacco use or secondhand smoke exposure. We propose to characterize the physicians who do not identify smoking and who do not counsel pregnant patients about tobacco use or secondhand exposure. This will be done in a three-stage process directed at physician behavior and community needs: 1) a local physician survey, 2) a mapping approach based on Geographic Information Systems (GIS), and 3) analysis of a national physician survey dataset. Tobacco use identification and counseling of pregnant smokers and nonsmokers will be the main outcome variables from both the local and national surveys. In the local survey, Los Angeles County obstetricians will be asked about their knowledge, attitudes, and behaviors regarding tobacco use and secondhand exposure in pregnant women. We will explore the relationships between counseling behavior of obstetricians and their knowledge and attitudes about tobacco use and secondhand smoke exposure. We will use GIS to create spatial density maps of maternal smoking in Los Angeles County, and study the relationship between density of maternal smoking and obstetrician counseling behavior. In the national survey, providers were asked about personal and practice characteristics, and patient visit information was collected. Vital statistics information will be used to compute the rate of maternal smoking in the provider's county, and along with provider and patient characteristics, this rate will be studied as a predictor of smoking identification and counseling. With the variety of tools and datasets obtained and compiled for this project, we will gain a better understanding of which physicians follow PHS, USPSTF, and ACOG guidelines, and how to identify those who do not.
The overarching goal of the proposed study is improvement of birth outcomes through reduction of fetal tobacco exposure. The results of this study will be useful in identifying physicians who need to improve their counseling to pregnant women about tobacco use and secondhand smoke exposure. The findings will help to target physicians for interventions to improve counseling and decrease fetal tobacco smoke exposure.
|Pineles, Beth L; Park, Edward; Samet, Jonathan M (2014) Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol 179:807-23|