Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.
Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA.
Nicotine Tob Res. 2020 Mar 16;22(3):346-353. doi: 10.1093/ntr/nty247.
National and international organizations have done an excellent job of advocating and promoting breast feeding for all mothers. This study assessed to what extent an intervention increased delivery of cessation assistance to breast-feeding mothers who smoke.
Data were collected between April and October 2015 in five US states as part of a cluster randomized controlled trial in 10 pediatric practices. Practices were randomized to the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention or usual care control arms. Mothers were asked about their smoking status and breast-feeding history during a screening interview upon exiting the practice and eligible mothers who agreed to participate in an enrollment interview were asked if they received smoking cessation assistance during their child's visit. Mothers with a child 1 year old and younger were included in the analyses.
Current breast feeding was associated with a reduced likelihood of current smoking (adjusted odds ratio [aOR] = 0.38, 95% confidence interval [95% CI] = 0.25 to 0.57) and a greater likelihood of quitting smoking (aOR = 2.33, 95% CI = 1.29 to 4.21) after controlling for known confounders. Mothers who concurrently smoked and breast-fed were more likely to be asked about smoking (66.7% vs. 28.6%, p = .01), advised to quit (61.1% vs. 21.4%, p < .01), prescribed nicotine replacement therapy (50.0% vs. 0%, p < .001), and enrolled into the quitline (27.8% vs. 0%, p < .01) at CEASE practices compared to control practices.
Breast-feeding mothers were less likely to be current smokers and more likely to have recently quit smoking. Among mothers who continue to smoke and breast feed, the CEASE intervention enhances delivery of smoking cessation assistance.
Breast feeding and eliminating infants' exposure to tobacco smoke are important protective factors for serious pediatric health risks including sudden infant death. This study shows that breast feeding was positively associated with desirable tobacco control outcomes, specifically that breast feeding was associated with a lower likelihood of smoking among ever smokers and a greater likelihood of recently quitting smoking. This is also the first study to look specifically at delivery of smoking cessation assistance to breast-feeding mothers seen at pediatric offices and demonstrates the effectiveness of delivering evidence-based smoking cessation assistance to them in this context.
www.ClinicalTrials.gov (identifier NCT01882348).
国家和国际组织在倡导和促进所有母亲母乳喂养方面做得非常出色。本研究评估了一项干预措施在多大程度上增加了向吸烟的母乳喂养母亲提供戒烟帮助。
数据收集于 2015 年 4 月至 10 月在美国五个州进行，作为 10 个儿科诊所中一项集群随机对照试验的一部分。实践随机分配到临床努力对抗二手烟暴露（CEASE）干预或常规护理对照组。母亲在离开诊所时通过筛查访谈被问及吸烟状况和母乳喂养史，符合条件的母亲如果同意参加入组访谈，则被问及在孩子就诊期间是否获得了戒烟帮助。对 1 岁及以下儿童的母亲进行了分析。
目前母乳喂养与当前吸烟的可能性降低相关（调整后的优势比[aOR] = 0.38，95%置信区间[95%CI] = 0.25 至 0.57），并且在控制了已知混杂因素后，戒烟的可能性增加（aOR = 2.33，95%CI = 1.29 至 4.21）。同时吸烟和母乳喂养的母亲更有可能被问及吸烟（66.7% vs. 28.6%，p =.01），被建议戒烟（61.1% vs. 21.4%，p <.01），被开尼古丁替代疗法（50.0% vs. 0%，p <.001），并在 CEASE 实践中比对照实践中更有可能被纳入戒烟热线（27.8% vs. 0%，p <.01）。
母乳喂养的母亲不太可能是当前吸烟者，并且更有可能最近戒烟。在继续吸烟和母乳喂养的母亲中，CEASE 干预增强了戒烟帮助的提供。
母乳喂养和消除婴儿接触烟草烟雾是预防包括婴儿猝死在内的严重儿科健康风险的重要保护因素。本研究表明，母乳喂养与理想的烟草控制结果呈正相关，具体来说，与曾经吸烟的人相比，母乳喂养与吸烟的可能性降低以及最近戒烟的可能性增加有关。这也是第一项专门研究向儿科诊所就诊的母乳喂养母亲提供戒烟帮助的研究，并证明了在这种情况下向她们提供基于证据的戒烟帮助的有效性。
www.ClinicalTrials.gov（标识符 NCT01882348）。
