title: Reducing smoking during pregnancy and postpartum: physician's advice supported by individual counseling.
abstract: BACKGROUND
  Physicians' advice to help pregnant women quit smoking during prenatal care has had mixed results. Training and prompting physicians to provide consistent advice and referral to on-site support might improve cessation rates.
  
  
  METHODS
  Pregnant women who smoked were randomly assigned to receive structured advice from their physician and referral to individual behavior change counseling during prenatal care or to receive brief advice to stop smoking and a quit smoking booklet at their first visit. Smoking status was measured by self-report, exhaled carbon monoxide, and urinary cotinine.
  
  
  RESULTS
  Compared with usual care, greater proportions of intervention group women reported not smoking at the 36th-week visit (14% vs 10%) and at 1 year postpartum (18% vs 11%), but these differences were not significant. However, significantly greater proportions of intervention group women reported either not smoking or reducing their cigarette consumption by 50% or more at their second visit (43% vs 29%, P = 0.02), at their 36th-week visit (40% vs 25%, P < 0.01), and at 1 year postpartum (26% vs 14%, P = 0.02).
  
  
  CONCLUSIONS
  Physician training on how to gain a pregnant smoker's commitment to change her smoking behavior, an office prompt system, and individualized smoking behavior change counseling show promise in reducing smoking during pregnancy and postpartum, but practical methods to assist pregnant smokers between regular prenatal visits, as they attempt to quit, need to be developed.
authors.affiliation: Office of Health Promotion Research, University of Vermont, Burlington 05401, USA. rseckerw@zoo.uvm.edu
authors.forename: R H
authors.initials: RH
authors.lastname: Secker-Walker
authors.forename: L J
authors.initials: LJ
authors.lastname: Solomon
authors.forename: B S
authors.initials: BS
authors.lastname: Flynn
authors.forename: J M
authors.initials: JM
authors.lastname: Skelly
authors.forename: P B
authors.initials: PB
authors.lastname: Mead
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D003367:Cotinine / Q000652:urine; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D007744:Obstetric Labor Complications; D049590:Postpartum Period; D011247:Pregnancy / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D018709:Statistics, Nonparametric
chemical_list: D003367:Cotinine