So near, yet so far: Tobacco dependence treatment for pregnant women

Abstract

Almost one-half million babies in the United States are born yearly to women who report smoking while pregnant. Almost all of these pregnant women have access to prenatal care, through federally financed health clinics, state and county health programs, or private providers. However, many pregnant smokers are unlikely to receive any type of counseling or assistance to help them stop smoking--despite the availability of evidence-based treatment and the considerable return on investment. This article recommends four next steps to ensure that tobacco dependence treatment is available for all pregnant women. These steps are (a). expanding Medicaid coverage for, and promotion of, effective counseling services for pregnant smokers, (b). improving health care systems by building the capacity of prenatal providers and health care systems to deliver effective treatments, (c). encouraging purchasers of private and public health benefit packages to demand coverage for, and promotion of, effective counseling services for pregnant smokers, and (d). redirecting state resources to ensure a statewide system of care for pregnant smokers. Implementation of these steps requires leadership, diligence, and action by the public health community--as well as ongoing monitoring to assess progress in improving coverage, capacity, and coordination.

Midwives' Knowledge, Perceptions, Beliefs, and Practice Supports Regarding Tobacco Dependence Treatment

“…This study supports the importance of system‐based interventions in adhering to clinical practice guidelines. The guidelines recommend the utilization of system‐based interventions 13 to improve tobacco dependence treatment, and other studies have demonstrated the benefits of utilizing office‐based strategies 36,37 . Tobacco cessation treatment should be viewed within the context of quality improvement and thus include targeting the entire practice environment, as well as including all practice clinicians and staff in participating in tobacco cessation treatment training.…”

Medicaid reimbursement for prenatal smoking intervention influences quitting and cessation

“…18 A suggested model for comprehensively addressing this goal for pregnant women includes: support from top leadership in the health organisation; clinical information systems to track individual patient information; ongoing training of providers and staff; the assignment of specific staff to provide smoking cessation counselling; innovative support systems for smokers trying to quit; and community support. 18 Increasing each state's capacity to deliver smoking cessation interventions needs to address the barriers that exist at the level of the prenatal provider. 11 14 30 Something as essential as a provider's awareness of changes in reimbursement for coverage needs to be considered.…”

“…13 Reimbursement for smoking cessation interventions during pregnancy is promoted as an important step to address key provider and system level barriers. [15][16][17][18][19] Recommendations for reimbursement are based on proven effectiveness of smoking cessation interventions 11 19 20 and evidence that they are cost effective, especially during the prenatal period. Every dollar spent on smoking cessation interventions for a pregnant smoker saves $3 in neonatal costs and $6 in long term care costs for infants with disabilities caused from smoking.…”

Epidemiology, determinants, and consequences of cigarette smoking in African American women: An integrative review

“…There are relatively large literatures that have examined smoking among women (Barker, Orleans, Halpin, & Barry, 2004; Cepeda-Benito, Reynoso, & Erath, 2004; Collins, et al, 2004; Patel, Bach, & Kris, 2004; Pauly, 2008; Reichert, Seltzer, Efferen, & Kohn, 2004; Schnoll, Patterson, & Lerman, 2007; Wetter, et al, 1999) and among African Americans (Brook, Saar, Zhang, & Brook, 2009; King, Polednak, Bendel, & Hovey, 1999; Lawrence, Graber, Mills, Meissner, & Warnecke, 2003; Moolchan, et al, 2007; Okuyemi, Pulvers, et al, 2007; Payne & Diefenbach, 2003; Pederson, Ahluwalia, Harris, & McGrady, 2000; Webb, 2008). Review articles on these topics have typically focused on differences between women and men without considering the concomitant role of ethnicity, or they have often focused on differences between African Americans and other ethnic groups without considering the role of gender [but see (Sanchez-Johnsen, 2005) for a review on smoking and obesity].…”