Health care providers' engagement in smoking cessation with pregnant smokers.
OBJECTIVE
To review how health care providers' (HCPs) engage in smoking cessation (SC) with pregnant smokers, and to examine the effect of system-level approaches and training initiatives to promote SC provision by HCPs.


METHODS
A comprehensive search of the CINAHL, COCHRANE Library, EMBASE, ERIC, MEDLINE, PsycINFO, and SIGLE databases was conducted.


METHODS
Selected studies assessed the behaviors of HCPs working among pregnant/postpartum girls and women, employed a quantitative approach, and had clearly defined behavioral outcomes of HCPs' delivery of SC to pregnant smokers.


METHODS
A total of 988 studies were obtained from the literature search, of which 28 publications met the inclusion criteria. The data extracted from the articles are presented under the following areas: how HCPs are engaging pregnant smokers and approaches to enhancing SC by HCP with pregnant smokers.


RESULTS
Although more than 50% of HCPs are likely to ask women about their smoking status and advise pregnant smokers to quit, fewer than 50% either assess readiness to change, assist in smoking cessation, or arrange for follow-up appointments/referrals. Important provider-specific, patient-specific, and system/organizational barriers were found to hinder the provision of SC by HCP. Several system-level and training approaches to enhancing HCP's engagement in SC with pregnant smokers show merit.


CONCLUSIONS
Few HCPs working with pregnant women use all the components of the Agency for Healthcare Research and Quality clinical guidelines. However, system-level and training approaches are effective ways to enhance HCP's engagement in SC; although, the effects of such initiatives may not be sustained. Factors such as the gender of the provider, geographical location, and the use of women-centered treatment approaches could be further examined in relation to provision of SC by HCPs among pregnant smokers.
Okoli
Chizimuzo T C
CTC
Tobacco Research Program at the British Columbia Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada.. Electronic address: cokoli@cw.bc.ca.
Greaves
Lorraine
L
Health System Strategy Division of the Ministry of Health and Long Term Care in the Province of Ontario and an investigator at the British Columbia Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada.
Bottorff
Joan L
JL
School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada.
Marcellus
Lenora M
LM
School of Nursing, University of Victoria, Victoria, British Columbia, Canada.
D000359:Aftercare; D001291:Attitude of Health Personnel; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D024382:Professional Role; D012017:Referral and Consultation; D012107:Research Design; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D014481:United States; D016270:United States Agency for Healthcare Research and Quality