Smoking-related activities in prenatal care programs

Convincing pregnant women who smoke to give up this behavior is one of the few universally agreed upon methods for improving pregnancy outcomes. An exploratory study was conducted to determine what public and quasi-public facilities serving pregnant women were doing to assist pregnant smokers in quitting, the reasons why more was not being done, and what could be done to increase smoking-cessation services.

Questionnaires eliciting information about pregnancy-related smoking prevention activities were mailed to home visitation projects, federally funded Healthy Start programs, CityMatCH members, and maternal and child health units in state health departments with a subsample of local health units. Responses were obtained from 354 programs.

Only about a quarter of the respondents thought they were doing enough to help pregnant smokers stop or reduce smoking, and most thought that the inadequacy was due to insufficient funds. Only about a quarter offered smoking-cessation classes or clinics. Almost all programs had policies restricting smoking in their offices. The nationally sponsored activity that the respondents felt might be most helpful in increasing their efforts was the provision of materials. Among the 313 programs that included home visits, 86% required the home visitors to conduct a needs assessment, and 97% of those expected the woman's smoking status to be recorded. Smoking status prior to pregnancy or by other household members was required less often. Less than half of the programs provided training on smoking-cessation/reduction methods to home visitors. Only 28% said smoking-cessation/reduction had a very high priority in comparison to other home visit objectives. CONCLUSIONS; Programs for pregnant women, including those with a home visit component, do not pay sufficient attention to the problem of smoking among their clients. Programs should make greater use of the evidence-based interventions now available.