title: Smoking cessation counseling with pregnant and postpartum women: a survey of community health center providers.
abstract: OBJECTIVE
  This study assessed providers' performance of smoking cessation counseling steps with low-income pregnant and postpartum women receiving care at community health centers.
  
  
  METHODS
  WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) program staff, obstetric clinicians, and pediatric clinicians at 6 community health centers were asked to complete surveys. Smoking intervention practices (performance), knowledge and attitudes, and organizational facilitators were measured. Factors associated with performance were explored with analysis of variance and regression analysis.
  
  
  RESULTS
  Performance scores differed significantly by clinic and provider type. Providers in obstetric clinics had the highest scores and those in pediatric clinics had the lowest scores. Nurse practitioners and nutritionists had higher scores than other providers. Clinic type, greater smoking-related knowledge, older age, and perception of smoking cessation as a priority were independently related to better counseling performance.
  
  
  CONCLUSIONS
  Mean performance scores demonstrated room for improvement in all groups. Low scores for performance of steps beyond assessment and advice indicate a need for emphasis on the assistance and follow-up steps of national guidelines. Providers' own commitment to helping mothers stop smoking was important.
authors.affiliation: Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester 01655, USA. jane.zapka@umassmed.edu
authors.forename: J G
authors.initials: JG
authors.lastname: Zapka
authors.forename: L
authors.initials: L
authors.lastname: Pbert
authors.forename: A M
authors.initials: AM
authors.lastname: Stoddard
authors.forename: J K
authors.initials: JK
authors.lastname: Ockene
authors.forename: K V
authors.initials: KV
authors.lastname: Goins
authors.forename: D
authors.initials: D
authors.lastname: Bonollo
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001900:Boston; D003151:Community Health Centers; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011181:Postnatal Care; D011203:Poverty; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care; D015397:Program Evaluation; D011787:Quality of Health Care; D016540:Smoking Cessation; D000074606:Smoking Prevention