Department of Public Health and Preventive Medicine, Oregon Health & Sciences University, Portland, OR, USA.
Matern Child Health J. 2010 Nov;14(6):901-9. doi: 10.1007/s10995-009-0522-x.
To explore racial/ethnic disparities in the receipt of optimal smoking cessation counseling during prenatal care. We used data from Oregon's perinatal surveillance system, the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) from 2000 to 2001. A stratified random sample of postpartum women were asked questions about events before, during and after pregnancy, including smoking and provision of smoking cessation counseling. The weighted response rate was 78.8% (n = 3,895). Receipt of a clinician protocol for smoking cessation intervention, called the Five A's (Ask, Advise, Assess, Assist, Arrange), was the outcome of interest. In the Oregon PRAMS survey, we asked women about three of the Five A's (Ask, Advise, Assist). Of 594 first trimester pregnant smokers, the majority were asked and advised about smoking by a prenatal care provider. However, a substantial proportion of women did not receive assistance to quit and only 42.2% received all three steps. Significant racial/ethnic variations were found only in the Assist step. Compared to non-Hispanic (NH) White women, NH American Indian women had lower odds (adjusted odds ratio [ORa]: 0.45; 95% confidence interval [95% CI] 0.24, 0.85) of receiving all three steps. In contrast, NH Black women had increased odds of receiving all three steps (ORa: 2.43; 95% CI 1.16, 5.10). We conclude that there is a need for prenatal care providers to address tobacco use, especially to Assist quitting, with all pregnant smokers. Healthcare systems should implement system prompts and supports for providers to remind them to address tobacco use with pregnant smokers.
探讨在产前护理中接受最佳戒烟咨询方面的种族/民族差异。我们使用了来自俄勒冈州围产期监测系统（俄勒冈州妊娠风险评估监测系统，PRAMS）的数据，时间范围为 2000 年至 2001 年。对产后妇女进行分层随机抽样，询问她们在怀孕前后的事件，包括吸烟和提供戒烟咨询。加权应答率为 78.8%（n=3895）。感兴趣的结果是接受临床医生戒烟干预方案，即五个 A（询问、建议、评估、协助、安排）。在俄勒冈州 PRAMS 调查中，我们询问了妇女有关五个 A 中的三个方面（询问、建议、协助）。在 594 名孕早期吸烟的妇女中，大多数人在产前护理提供者那里被询问和建议戒烟。然而，相当一部分妇女没有得到戒烟帮助，只有 42.2%的人接受了所有三个步骤。仅在协助步骤中发现了显著的种族/民族差异。与非西班牙裔（NH）白人女性相比，NH 美洲印第安女性接受所有三个步骤的可能性较低（调整后的优势比[ORa]：0.45；95%置信区间[95%CI]0.24，0.85）。相比之下，NH 黑人女性接受所有三个步骤的可能性增加（ORa：2.43；95%CI 1.16，5.10）。我们得出的结论是，产前护理提供者需要解决烟草使用问题，尤其是要协助所有孕妇戒烟。医疗保健系统应实施系统提示和支持，提醒提供者解决孕妇的烟草使用问题。
