Opportunities Missed: A Cross-Sectional Survey of the Provision of Smoking Cessation Care to Pregnant Women by Australian General Practitioners and Obstetricians

Abstract

Improving provision of the 5A's approach should focus on the individual level, including better training for GPs and Obstetricians, designed to improve specific "internal" barriers such as confidence in counselling and optimism. The AAR may be easier to implement in view of the higher overall performance of this approach. Interventions on a more systemic level need to ensure easy, effective, and acceptable referral mechanisms are in place. More research is needed specifically on the acceptability of the Quitline for pregnant women, both Indigenous and non-Indigenous.

Smoking during pregnancy in the United States, 2005–2014: The role of depression

“…(Mohsin and Bauman, 2005) In fact, low-income women commonly have the lowest utilization of smoking cessation counseling services (Scheuermann et al, 2017) and interventions have been developed and evaluated to promote smoking cessation among pregnant women (Naughton et al, 2017). Most recently, smoking cessation interventions with a physical activity component targeting pregnant women have been suggested, interventions supplementing smoking cessation materials with text messaging, as well as broadening the scope of smoking screening programs to include general practitioners and obstetricians have been suggested (Giatras et al, 2017; Zeev et al, 2017; Naughton et al, 2017). Further, although smoking cessation in pregnancy has been associated with decreased depressive symptoms, implying a further benefit of large-scale smoking cessation programs, large-scale community-based trials that target depression reduction to improve smoking cessation rates among pregnant women at a population level have not been conducted (Munafo et al, 2008).…”

Are we missing an opportunity to improve smoking cessation rates for pregnant women?

“…Alternatively, a more intensive and tailored approach needs to be investigated such as specialist cessation clinics. 9 Pharmacotherapy is considered a first-line approach for smoking cessation in the general population and has shown to be effective. 12 There is limited evidence, however, of the safety of pharmacotherapy in pregnancy and the effect it has on the developing foetus.…”

“…7,8 A survey of general practitioners (GPs) and obstetricians in Australia reported that although 75 per cent of physicians "always" performed the "ask" and "advise" components of the 5As strategy, less than 33 per cent "always" performed the rest of the components of this approach. 9 Additionally, referral rates to Quitline are low, especially for GPs managing a higher proportion of indigenous patients. 9 This may be evidence that despite pregnancy being a unique and strong TM, healthcare professionals involved in the care of these women are not successfully maximising the TM to promote smoking cessation.…”

“…9 Additionally, referral rates to Quitline are low, especially for GPs managing a higher proportion of indigenous patients. 9 This may be evidence that despite pregnancy being a unique and strong TM, healthcare professionals involved in the care of these women are not successfully maximising the TM to promote smoking cessation. There is scope for additional strategies to maximise the potential advantages of pregnancy as a TM to promote healthy lifestyle interventions.…”

“…There is scope for additional strategies to maximise the potential advantages of pregnancy as a TM to promote healthy lifestyle interventions. 9 Evaluation of other smoking cessation strategies for pregnant women have variable results. Proactive telephone support delivered by a professional as an adjunct intervention has been suggested to assist in preventing smoking relapse but has no effect on …”