title: When pregnant patients disclose substance use: missed opportunities for behavioral change counseling.
abstract: OBJECTIVE
  The first obstetric visit is an opportunity to provide counseling to women with substance abuse risks, including smoking, drug use, and alcohol use. Little is known about how obstetric care providers and patients discuss these issues. Our objective was to examine patient-provider communication about substance use behaviors during these visits.
  
  
  METHODS
  We audio-taped and transcribed verbatim first prenatal visits in an outpatient hospital clinic, then qualitatively analyzed them for content and process of communication using modified grounded theory methods.
  
  
  RESULTS
  Twenty-nine providers (21 residents, 5 midwives, 3 nurse practitioners) and 51 patients participated. Twenty-five patients were smokers, 4 used alcohol, and 11 used drugs. Provider responses to smoking disclosures included discussions of risks, encouragement to quit-cut down, affirmation of attempts to quit-cut down, and referral to smoking cessation programs. Responses to alcohol or drug disclosures included only a general statement regarding risks and referral to genetics.
  
  
  CONCLUSIONS
  Providers were less attentive to alcohol and drugs than smoking where they had pre-established patterns of response.
  
  
  CONCLUSIONS
  Providers should discuss behavioral change strategies and motivations with pregnant patients who use drugs and/or alcohol as well as those who smoke.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences and Medicine, University of Pittsburgh, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213, United States. jchang@mail.magee.edu
authors.forename: Judy C
authors.initials: JC
authors.lastname: Chang
authors.forename: Diane
authors.initials: D
authors.lastname: Dado
authors.forename: Richard M
authors.initials: RM
authors.lastname: Frankel
authors.forename: Keri L
authors.initials: KL
authors.lastname: Rodriguez
authors.forename: Susan
authors.initials: S
authors.lastname: Zickmund
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Ling
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control*; D037001:Directive Counseling; D005260:Female; D006801:Humans; D008403:Mass Screening; D010414:Pennsylvania; D011247:Pregnancy; D011295:Prenatal Care; D011369:Professional-Patient Relations; D000074606:Smoking Prevention; D019966:Substance-Related Disorders / Q000517:prevention & control*