title: Smoking is bad for babies: obstetric care providers' use of best practice smoking cessation counseling techniques.
abstract: OBJECTIVE
  To use direct observations of first prenatal visits to describe obstetric providers' adherence to the evidence-based clinical practice guideline for smoking cessation counseling recommended by the American College of Obstetricians and Gynecologists, the 5 A's (Ask, Advice, Assess, Assist, and Arrange).
  
  
  METHODS
  Observational study using audio recordings of first obstetric visits.
  
  
  METHODS
  An urban academic hospital-based clinic.
  
  
  METHODS
  Obstetric care providers and pregnant women attending their first obstetric visit.
  
  
  METHODS
  First obstetric visits were audio recorded. Visits were identified in which patients reported smoking, and discussions were analyzed for obstetric providers' use of the 5 A's in smoking cessation counseling.
  
  
  RESULTS
  Obstetric providers asked about smoking in 98% of the 116 visits analyzed, but used 3 or more of the 5 A's in only 21% (24) of visits. In no visits did providers use all 5 A's. In 54% of the visits, providers gave patients information about smoking, most commonly about risks associated with perinatal smoking.
  
  
  CONCLUSIONS
  Few obstetric care providers performed the recommended 5 A's smoking cessation counseling with their pregnant smokers. Effective and innovative methods are needed to improve obstetric providers' use of the 5 A's.
authors.affiliation: Center for Research in Health Care, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA. jchang@mail.magee.edu
authors.forename: Judy C
authors.initials: JC
authors.lastname: Chang
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Holland
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.forename: Douglas
authors.initials: D
authors.lastname: Landsittel
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.forename: Kathryn I
authors.initials: KI
authors.lastname: Pollak
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000379:methods* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012907:Smoking / Q000009:adverse effects / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D055815:Young Adult