title: Getting focused: missed opportunities for smoking interventions for pregnant women receiving Medicaid.
abstract: BACKGROUND
  The prevalence of smoking, and cessation and relapse rates for pregnant women have health and financial implications. Our objectives were to describe smoking among pregnant smokers receiving Medicaid including characteristics associated with reporting discussion of smoking with providers and the association between those discussions with quitting and maintenance.
  
  
  METHODS
  Analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 15 states for 20,287 women with Medicaid for prenatal care during 1998-2000.
  
  
  RESULTS
  Thirty-four percent of women smoked before pregnancy (N = 7,686). Most smokers (93%) and nonsmokers (88%) reported discussions about smoking during prenatal care. Women were less likely to have discussed smoking if they were lighter smokers (OR = 1.47; CI = 1.03, 2.12), or reported a previous low-birthweight infant (OR = 1.72; CI = 1.03-2.86). Women reporting discussions (compared to those not) were less likely to quit (ARR = 0.70: CI = 0.59-0.91). Quitters reporting discussions (compared to those not) were no more likely to maintain cessation (ARR = 0.89; CI = 0.7, 1.21).
  
  
  CONCLUSIONS
  Smoking cessation interventions can be improved for pregnant women receiving Medicaid, especially if focused to address individual needs of light smokers, those with previous low-birthweight infants, or those who find it most difficult to quit.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. ruth_petersen@unc.edu
authors.forename: Ruth
authors.initials: R
authors.lastname: Petersen
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Clark
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Hartmann
authors.forename: Cathy L
authors.initials: CL
authors.lastname: Melvin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D011247:Pregnancy; D016540:Smoking Cessation; D014481:United States