Evaluation of Pregnant and Postpartum Women s Use of Quitlines:

Transcription

1 Evaluation of Pregnant and Postpartum Women s Use of Quitlines: Overview and lessons learned Patricia Dietz, DrPH Epidemiologist, Team Leader Research and Evaluation Team December 8 &10, 2010 National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health

2 Public Health Problem Consequences of smoking around pregnancy 1 Before conception: reduced fertility, delayed conception During pregnancy: placenta previa, placental abruption, premature rupture of membranes, preterm delivery, restricted fetal growth, Sudden Infant Death Syndrome (SIDS) Second hand smoke exposure 2 After delivery: respiratory tract infections and SIDS Prenatal smoking is attributable to 5% 8% of preterm deliveries, 13% 19% of term low birth weight deliveries, 23% 34% of SIDS, and 5% 7% of pretermrelated deaths SG report: The health consequences of smoking; SG report: The health consequences of involuntary exposure to tobacco smoke; 3. Dietz et al. AJPM 2010

3 Percent of mothers who smoked during pregnancy in US, birth certificates * * Birth certificates, National Center for Health Statistics; excludes California.

4 Prenatal Smoking Patterns 1 One in 5 women smoke pre-pregnancy Approximately 50% of women quit smoking by late pregnancy Prenatal smokers Higher in <25 years of age; higher among non-hispanic Whites, American Indians, or Alaska Natives Have stressors in their lives such as poverty, live with a smoker, and are highly addicted Among women who quit during pregnancy, half relapsed to smoking after delivery 1.Tong et al. Trends in smoking before, during, and after pregnancy PRAMS, US, 31 sites,

5 CDC Initiative CDC DRH and Office on Smoking and Health funded 3 universities to evaluate the use of quitlines (QLs) for pregnant and postpartum smokers ( ) University of Medicine and Dentistry of New Jersey, PI: Rick Boyd West Virginia, WV Prevention Research Center, PI: Kimberly Horn University of Wisconsin Center for Tobacco Research and Intervention, PI: Michael Fiore

6 LESSONS LEARNED

7 Prenatal Care Providers and Clinical Practice Guidelines for Treating Tobacco Dependence Among OB/GYNs and nurse midwives: 10% reported that they implement them 9% have read them 43% have heard of them 39% have not heard of them * New Jersey survey of OB/GYNs and nurse midwives

8 Barriers cited: Provider Referrals to QLs Lack of time with patients, patient resistance Lack of knowledge about the QL Frustrated that referrals do not lead to connection Fear of losing rapport with women In general, providers liked referring to the QL, and faxto-quit model made it easier Promote use among prenatal care providers Developing brief messages that providers can tell patients about the QL (e.g., How does the QL work; QL have pregnancy protocols) Including provider prompts/reminders and feedback about the QL Educating all prenatal care providers about QLs *New Jersey survey and Wisconsin structure interview data among providers

9 Pregnant Women s Use of QL 86% of women are aware of QL 55% believe it to be effective 9% reported using the QL during pregnancy 80% of women made a quit attempt during pregnancy *Wisconsin postpartum survey data

10 *Wisconsin postpartum survey data Quitting Methods

11 Summary Prenatal care providers are not implementing guidelines due to lack of knowledge, time & training constraints, and patient disinterest QLs are resource that they can refer patients to However, providers need knowledge about the QL Pregnant women are aware of the QLs but many prefer to try to quit on their own

12 Public Health Implications Continued outreach is needed to inform prenatal care providers on the benefit of QLs and how to promote QLs among their patients Providers who knew about the QL had confidence in the service Prompts and reminders to refer to the QL would be helpful More research is needed to understand pregnant women s preference to make quit attempts on my own and reluctance to use evidence-based treatments. Messages are needed to inform pregnant women that they are more likely to be successful quitting if they receive support from the QL

13 Acknowledgements CDC: Van Tong, Ann Malarcher, Lei Zhang, Jennifer Bombard NJ: Rick Boyd, Heather Jordan, Cristine D. Delnevo WV: Robert H. Anderson, Cindy Tworek, Kimberly Horn WI: Kate Kobinsky, Douglas Jorenby

14 Resources ACOG : Committee opinion no. 471: Smoking cessation during pregnancy. Obstet Gynecol Nov;116(5): Pregnancy and Postpartum Quitline Toolkit

15 Tobacco Use and Pregnancy Website: Patricia Dietz For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health