Perlen Susan, Brown Stephanie J, Yelland Jane
Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.
Birth. 2013 Jun;40(2):81-7. doi: 10.1111/birt.12036. Epub 2013 Mar 25.
Antenatal smoking cessation guidelines have been available in Victoria, Australia, for the past decade. The objective of this study was to assess to what extent introduction of smoking cessation guidelines in pregnancy changed practice in Victorian public hospitals.
Two population-based postal surveys of women giving birth in the state of Victoria, conducted in 2000 and 2008 before and after implementation of smoking cessation guidelines. Self-administered questionnaires were distributed by hospitals and home birth practitioners to women 5-6 months postpartum.
Surveys were completed and returned by 67 percent of eligible women (1,616/2,412) in 2000 and 51% (2,900/5,681) in 2008. Compared with the 2000 survey, women in the 2008 survey attending public sector care were more likely: to receive advice on how to stop smoking (Adjusted Odds Ratio: 2.2, 95% CI 1.5-3.2); to be given written information (Adj OR: 2.7, 95% CI 1.8-4.0); to be referred to stop smoking programs (Adj OR: 6.1, 95% CI 3.1-11.7); and to have discussed smoking cessation at more than one visit (Adj OR: 1.5, 95% CI 1.0-2.2). While the majority of women in both surveys were asked about smoking in early pregnancy, about half of those smoking did not receive advice on how to stop or cut down; were not given written information; were not told about/referred to stop smoking programs and were not asked again about smoking at subsequent visits. The significant shift in women's reports of receiving smoking cessation advice and support between the two surveys occurred predominantly at public hospitals where women received all or some antenatal care.
Smoking cessation guidelines in Victorian public hospitals have increased the extent to which pregnant women receive advice and support to stop or reduce smoking. However, half of smokers did not receive the full complement of advice and support according to state guidelines, with marked variability according to where and from whom women received antenatal care. Further efforts are needed to implement smoking cessation advice and support in clinical practice.
在过去十年中，澳大利亚维多利亚州已有产前戒烟指南。本研究的目的是评估孕期戒烟指南的引入在多大程度上改变了维多利亚州公立医院的做法。
在戒烟指南实施前后，于2000年和2008年对维多利亚州分娩的妇女进行了两次基于人群的邮政调查。医院和家庭分娩从业者向产后5至6个月的妇女发放自行填写的问卷。
2000年67%（1,616/2,412）符合条件的妇女完成并返回了调查问卷，2008年这一比例为51%（2,900/5,681）。与2000年的调查相比，2008年接受公共部门护理的妇女更有可能：接受如何戒烟的建议（调整后的优势比：2.2，95%可信区间1.5 - 3.2）；收到书面信息（调整后的优势比：2.7，95%可信区间1.8 - 4.0）；被转介到戒烟项目（调整后的优势比：6.1，95%可信区间3.1 - 11.7）；以及在不止一次就诊时讨论过戒烟（调整后的优势比：1.5，95%可信区间1.0 - 2.2）。虽然两项调查中的大多数妇女在孕早期都被询问过吸烟情况，但约一半吸烟的妇女没有得到如何戒烟或减少吸烟的建议；没有收到书面信息；没有被告知/被转介到戒烟项目，并且在后续就诊时没有再次被询问吸烟情况。两次调查之间妇女报告接受戒烟建议和支持的显著变化主要发生在公立医院，在那里妇女接受了全部或部分产前护理。
维多利亚州公立医院的戒烟指南增加了孕妇获得戒烟或减少吸烟建议和支持的程度。然而，根据该州指南，一半的吸烟者没有得到完整的建议和支持，根据妇女接受产前护理的地点和人员不同，存在显著差异。需要进一步努力在临床实践中实施戒烟建议和支持。
