Smoking Cessation Counseling during Pregnancy at Strong Memorial Hospital

1. Smoking Cessation Counseling during Pregnancy at Strong Memorial Hospital Paul Cabral MD Loralei Thornburg MD Christopher Glantz MD, MPH Department of Obstetrics and Gynecology University of Rochester Strong Memorial Hospital

2. Risks of Smoking • Low birth weight (4x) • Very preterm birth • Premature rupture of membrane • Abruption • Spontaneous abortions (1.6 x) • Cleft lip and palate • Placenta Previa • Infant deaths ~1000 per year • Respiratory infection (225,000) • Developmental Disabilities CDC MMWR Weekly

3. National Impact • Smoking rates during pregnancy • 3-26 % of pregnancy in United States • 17 % of pregnancy at SMH • Attributable medical cost • $200-$400 million/year- neonatal • $ 4 billion/year overall cost CDC MMWR Weekly Treasury Department, Office of Economic Policy Estimate

4. If they quit……? • 46% of smokers quit during pregnancy • Cessation prior to 3rd trimester decrease most of smoking-related low birth weight • If the final 54% quit… • 5% reduction in fetal and infant death • 10 % reduction in incidence LBW ACOG Committee Opinion #317

5. Previous Research • Demonstrated that smoking cessation counseling is successful in pregnancy • Asked only obstetricians’ opinions on smoking cessation counseling • Few prior studies assess the patient’s prospective in pregnancy

6. Specific aims • Is smoking cessation counseling being offered in pregnancy? • What is the perception of smoking cessation counseling by pregnant women? • What is the perception of smoking cessation counseling by obstetrical providers.

7. Study Design • Retrospective cohort survey • Ages 18 years and older • Survey on 1st or 2nd post-partum day • Email Survey to Prenatal Providers

8. Demographics Patients

9. Demographics Obstetric Providers

10. Smoking Characteristics Before Pregnancy

11. Smoking Characteristics During Pregnancy Not significantly different than before pregnancy

12. Smoking Reduction Attempts

13. Physician’s Counseling: Patient’s Perspective

14. Smoking Cessation Aids

15. Comparison of Time Spent Counseling

16. Comparison of Counseling

17. Patient’s Barriers to CessationPhysician’s Perspective

18. Physician’s Barriers to Counseling

19. Smoking Cessation Aids Trained

20. Time Trained

21. NRT During Pregnancy

22. Conclusions • About 50% of participants claimed to have stopped smoking for at least part of their pregnancy.  • Most of them did not use the methods offered. • Most used cold turkey or gradual reduction. • Majority felt that their doctors spent enough time and gave enough information. • However, the information was not very useful.

23. Conclusions • Different perceptions • Patient vs. Providers • Knowledge deficit • Providers & Patients • Very little training • < 2 hours

24. Future • Patient and Physicians’ Survey • Expanding Research to the Finger Lakes Region • Validation of Survey • Focus Groups • Defining the word “Useful” • Implement strategies to improve smoking cessation during pregnancy