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PRE-NATAL PROGRAMS FALL SHORT ON SMOKING CESSATION

     By Aaron Levin, Staff Writer
     Health Behavior News Service

August 7, 2003
Administrators of three out of four prenatal programs for low-income
women admit they aren’t doing enough to help pregnant women quit or
reduce their smoking, a new study shows.

This provides a discouraging view of the smoking-cessation activities
of the agencies that serve pregnant women, says Lorraine Klerman,
Dr.P.H, of Brandeis University. Agency staff members believe that pregnant
women have more important problems than smoking. They feel that it is
difficult if not impossible to convince pregnant women to stop smoking,
and lack materials to help them do so.

In a study appearing in the American Journal of Preventive Medicine,
Klerman and Crystal Spivey, Dr.P.H, of the University of Alabama at
Birmingham surveyed 354 public and quasi-public organizations that offered
prenatal care, especially to low-income women.

According to the U.S. Public Health Service, women who smoke are likely
to have more stillbirths, spontaneous abortions, and premature babies
compared to non-smokers. Their babies are also more likely to have lower
birth weight, sudden infant death syndrome, cleft palate and childhood
cancers. Helping women quit smoking when they’re pregnant can benefit
the future health of their children.

The organizations surveyed offered care both at clinics and by visiting
women in their homes. They included federally funded Healthy Start
programs and a variety of maternal and child health programs run by states
and cities around the United States.

Only 24 percent of the agencies thought they were doing an adequate job
of getting women to stop smoking. Most of those who acknowledged they
weren’t doing a good enough job cited insufficient agency funds and lack
of staff time as reasons. Others said that clients had more important
problems to worry about. About a third blamed a shortage of specialists
to train staff.

Only a quarter of the programs offered smoking cessation classes, but
most of those said it was hard to get clients in the door. They
attributed this to lack of encouragement from clients' family members, lack of
child care, long waiting lists and inconvenient hours or locations.

Agencies also asked for more smoking cessation materials, guidelines
for proven ways to combat smoking and training at professional meetings.

Most agencies that visited pregnant women in their homes required staff
to record their clients' smoking status and expected them to counsel
pregnant smokers about the effects of smoking. However, less than half
the agencies said they trained the home visitors in smoking reduction or
cessation methods. Client problems like drug addiction or domestic
violence ranked higher on these workers priority lists.

All individuals and groups serving pregnant women need to direct more
effort to helping smokers quit, Klerman says. They need experts to
educate staff, pregnancy-specific smoking materials, manuals of best
practices and changes in agency policies

She suggests making smoking education programs part of every staff
orientation program and requiring agency workers to record pre-pregnancy
smoking status and inquire about other smokers in the household.

Clearly more research is needed, Klerman says, not only about how to
convince pregnant women to stop smoking but also about how to convince
clinicians to use methods known to be effective.

Grants from the Robert Wood Johnson Foundation and the Maternal and
Child Health Bureau of the U.S. Department of Health and Human Services
supported the research.

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FOR MORE INFORMATION:
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Contact Lorraine V. Klerman at (781) 736-3715 or
klerman@brandeis.edu.
American Journal of Preventive Medicine: Contact the editorial office
at (619) 594-7344.

This story is also available online at
www.hbns.org/news/prenatal08-07-03.cfm.