Russell Toya, Crawford Myra, Woodby Lesa
University of Alabama at Birmingham School of Medicine, Department of Family and Community Medicine, Birmingham, AL 35294, USA.
Nicotine Tob Res. 2004 Apr;6 Suppl 2:S141-51. doi: 10.1080/14622200410001669141.
Tobacco smoke exposure during and after pregnancy may cause maternal, fetal, and infant morbidity and mortality. The purpose of this review is to (a). describe existing methods of measuring active tobacco exposure among pregnant women and (b). illustrate the usefulness of these measures in validating self-reported smoking status among these women. Medline, PsycINFO, and Academic Search Elite were used to identify measures of cigarette smoking exposure, prevalence reports, cessation and validity studies, and research on deception about smoking during pregnancy. Review of the research on smoking cessation among pregnant women since 1966 revealed that 36% of studies (9 out of 25) located used only self-report to assess smoking status. The remaining 16 studies used either significant other reports or at least one type of biochemical test to confirm self-report. Deception rates were reported at baseline only, follow-up only, or both in 15 studies. Three federal agencies in the United States collect data on self-reported smoking during pregnancy. Smoking prevalence rates are inconsistent among these agencies. This article demonstrates that measuring smoking status during pregnancy via self-report alone leads to discrepancies in national prevalence rates, deceptions in clinical practice disclosure, and inconsistencies in research study results. Evaluation studies that confirm smoking status among pregnant women by biochemical methods provide more accurate prevalence rates and lead to the most effective behavioral interventions to achieve cessation. National statistics should carry a disclaimer indicating the likelihood of underestimation. Researchers and clinicians should be trained in best-practice, evidence-based behavioral methods to assess prenatal smoking status and to assist those who desire to quit.
孕期及产后接触烟草烟雾可能会导致孕产妇、胎儿和婴儿发病及死亡。本综述的目的是:(a)描述现有的测量孕妇主动接触烟草情况的方法,以及(b)说明这些测量方法在验证这些女性自我报告的吸烟状况方面的实用性。利用医学期刊数据库(Medline)、心理学文摘数据库(PsycINFO)和学术搜索精英数据库(Academic Search Elite)来识别吸烟暴露的测量方法、患病率报告、戒烟及效度研究,以及关于孕期吸烟瞒报情况的研究。对1966年以来有关孕妇戒烟的研究进行回顾发现,所找到的25项研究中有36%(9项)仅使用自我报告来评估吸烟状况。其余16项研究则使用重要他人报告或至少一种生化检测来确认自我报告。在15项研究中,瞒报率仅在基线期、仅在随访期或在基线期和随访期均有报告。美国三个联邦机构收集孕期自我报告吸烟情况的数据。这些机构的吸烟患病率并不一致。本文表明,仅通过自我报告测量孕期吸烟状况会导致全国患病率出现差异、临床实践披露中存在瞒报情况以及研究结果不一致。通过生化方法确认孕妇吸烟状况的评估研究能提供更准确的患病率,并能带来最有效的行为干预措施以实现戒烟。国家统计数据应附带一份免责声明,说明存在低估的可能性。研究人员和临床医生应接受基于最佳实践和循证的行为方法培训,以评估产前吸烟状况,并帮助那些想要戒烟的人。