Secker-Walker R H, Solomon L J, Flynn B S, Skelly J M, Mead P B
Office of Health Promotion Research, University of Vermont, Burlington 05401, USA.
Prev Med. 1998 May-Jun;27(3):422-30. doi: 10.1006/pmed.1998.0287.
Physicians' advice to help pregnant women quit smoking during prenatal care has had mixed results. Training and prompting physicians to provide consistent advice and referral to on-site support might improve cessation rates.
Pregnant women who smoked were randomly assigned to receive structured advice from their physician and referral to individual behavior change counseling during prenatal care or to receive brief advice to stop smoking and a quit smoking booklet at their first visit. Smoking status was measured by self-report, exhaled carbon monoxide, and urinary cotinine.
Compared with usual care, greater proportions of intervention group women reported not smoking at the 36th-week visit (14% vs 10%) and at 1 year postpartum (18% vs 11%), but these differences were not significant. However, significantly greater proportions of intervention group women reported either not smoking or reducing their cigarette consumption by 50% or more at their second visit (43% vs 29%, P = 0.02), at their 36th-week visit (40% vs 25%, P < 0.01), and at 1 year postpartum (26% vs 14%, P = 0.02).
Physician training on how to gain a pregnant smoker's commitment to change her smoking behavior, an office prompt system, and individualized smoking behavior change counseling show promise in reducing smoking during pregnancy and postpartum, but practical methods to assist pregnant smokers between regular prenatal visits, as they attempt to quit, need to be developed.
在产前护理中，医生帮助孕妇戒烟的建议效果不一。培训并促使医生提供一致的建议并转介至现场支持可能会提高戒烟率。
吸烟的孕妇被随机分配，一组在产前护理期间接受医生的结构化建议并转介至个体行为改变咨询，另一组在首次就诊时接受简短的戒烟建议和一本戒烟手册。通过自我报告、呼出一氧化碳和尿可替宁来测量吸烟状况。
与常规护理相比，干预组中更多比例的女性在第36周就诊时报告已戒烟（14%对10%），以及在产后1年时报告已戒烟（18%对11%），但这些差异并不显著。然而，在第二次就诊时（43%对29%，P = 0.02）、第36周就诊时（40%对25%，P < 0.01）以及产后1年时（26%对14%，P = 0.02），干预组中报告已戒烟或减少吸烟量50%及以上的女性比例显著更高。
关于如何促使吸烟孕妇承诺改变其吸烟行为的医生培训、办公室提示系统以及个体化吸烟行为改变咨询，在减少孕期和产后吸烟方面显示出前景，但需要开发实用的方法来帮助处于尝试戒烟阶段的吸烟孕妇在定期产前检查之间的时段戒烟。
