title: An examination of attitudes, knowledge, and clinical practices among Pennsylvania pediatricians regarding breastfeeding and smoking.
abstract: OBJECTIVE
  The most recent American Academy of Pediatrics policy statement clearly supports breastfeeding for smoking mothers. The impact of this recommendation on pediatricians' counseling and prescribing practices is unclear. This study describes Pennsylvania pediatricians' attitudes, knowledge, and practices regarding breastfeeding, maternal smoking, and smoking cessation.
  
  
  METHODS
  A descriptive study was conducted using a web-based, anonymous survey. The survey consisted of three clinical vignettes followed by knowledge and attitude questions.
  
  
  RESULTS
  Among 296 respondents, more than half reported one or more conversations about breastfeeding and smoking in the past year. Most were comfortable counseling on breastfeeding, but few were comfortable counseling about smoking and breastfeeding. Respondents scored poorly on five knowledge items; 27% answered zero items correctly, and only 21% answered four or five items correctly. Less than half reported breastfeeding was safe for smoking mothers. Compared to pediatricians with high knowledge scores, those with a low score were less likely to tell a smoking mother that breastfeeding is safe (38% vs. 69%, p < 0.01) and more likely to recommend formula feeding (19% vs. 3%, p < 0.01). Most pediatricians were uncertain about the safety of nicotine replacement therapy and bupropion (Zyban, GalxoSmithKline, Research Triangle Park, NC) with breastfeeding.
  
  
  CONCLUSIONS
  Pennsylvania pediatricians lack knowledge and comfort related to the topic of breastfeeding and maternal smoking. Additional efforts to inform and educate pediatricians on the subjects of breastfeeding, maternal tobacco use, and smoking cessation products are needed.
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Lucero
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Moss
authors.forename: Erin D
authors.initials: ED
authors.lastname: Davies
authors.forename: Kathleen
authors.initials: K
authors.lastname: Colborn
authors.forename: Wesley C
authors.initials: WC
authors.lastname: Barnhart
authors.forename: Debra L
authors.initials: DL
authors.lastname: Bogen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D016642:Bupropion / Q000009:adverse effects / Q000378:metabolism; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008895:Milk, Human / Q000378:metabolism; D009538:Nicotine / Q000009:adverse effects / Q000378:metabolism; D010372:Pediatrics / Q000706:statistics & numerical data*; D010414:Pennsylvania; D010818:Practice Patterns, Physicians'; D012449:Safety; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation; D011795:Surveys and Questionnaires
chemical_list: D016642:Bupropion; D009538:Nicotine