Transcript Postpartum Depression Smoking Cessation Companion slides

Smoking Cessation for
Pregnancy and Beyond:
Virtual Clinic Companion Slides
Catherine A. Powers, EdD, LSW
PACE – Tobacco Prevention and
Cessation Education
for Medical School Students
Boston University School of Medicine
Funded by NCI R25-CA9 1958-04
Smoking Mortality and Morbidity
in the United States
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Smoking is the single most preventable cause of deaths in the
United States
Smoking-related disease and complications account for
450,000 deaths each year in the United States
It is estimated that between 12 and 20% of pregnant women in
the US smoke
Association of Women’s Health Obstetric and Neonatal Nurses, 2002;
Martin, J.A., et al. Births: Final Data for 2002. National Vital Statistics Reports, volume 52,
number 10, Dec. 2003.
Smoking and Women’s Unique Risks
All smokers are at risk of heart disease, stroke, cancer and
pulmonary disease
 Women have additional risks related to menstrual and
reproductive functions
- Increased risk of conception delay at primary and secondary
infertility
- Increased risk of ectopic pregnancy and
spontaneous abortion
- Earlier menopause with more severe symptoms
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US Department of Health and Human Services, The Health Consequences of Smoking: A Report of the
Surgeon General (2004)
The Risks of Smoking
During Pregnancy
Premature rupture of the membranes
 Abruptio placentae
 Preterm delivery
Smoking during pregnancy accounts for:
 20% of Low birth weight babies
 8% of pre-term deliveries
 5% of prenatal deaths
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US Department of Health and Human Services, Surgeon General’s Report 2001: Women and Smoking
The Benefits of Quitting
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Women who quit smoking before or during
pregnancy reduce the risk for adverse reproductive
outcomes, including:
conception delay
infertility
premature rupture of membranes
preterm delivery
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low birth weight
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US Department of Health and Human Services, Surgeon General’s Report 2001: Women and Smoking
Quitting during Pregnancy
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A higher percentage of women stop smoking during pregnancy, both
spontaneously and with assistance than at other times in their lives.
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Using pregnancy-specific programs can increase smoking cessation rates,
which benefits infant health and is cost effective.
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Within 6 months of delivery women who quit smoking immediately after learning
they are pregnant (spontaneous quitters) have a 70% relapse rate
Smoking Cessation in Pregnancy: A Review of Postpartum Relapse Prevention Strategies
J Am Board Fam Pract 17(4):264-275, 2004.
US Department of Health and Human Services, Surgeon General’s Report 2001: Women and Smoking
Pharmacotherapy
and the Pregnant Smoker
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The efficacy of nicotine replacement therapy in pregnancy is not known
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The only completed and published randomized controlled trial of nicotine
replacement (delivered by transdermal patches) showed no difference from
placebo, but the numbers studied were small, and the trial was underpowered
to determine whether nicotine replacement was effective.
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Researchers did find that babies born to women in the nicotine treatment
group had significantly higher birth weights than those in the placebo group
indicating that the intrauterine growth restriction caused by smoking is
probably not attributable to nicotine.
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More research is needed to determine the effects of nicotine replacement
therapy on pregnant women and their offspring.
‘Nicotine replacement therapy in pregnancy’ BMJ 2004;328:965-966
Tobacco Cessation Programs
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Women are more likely than men to use
intensive treatment programs.
Women have a stronger interest than men in
smoking cessation groups that offer mutual
support through a buddy system and in
treatment meetings over a long period.
US Department of Health and Human Services, Surgeon General’s Report 2001:
Women and Smoking
Smoking Cessation Groups
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There are two types of smoking cessation
groups that are discussed in the literature
Support groups also labeled self-help groups
Group counseling with a trained facilitator
Support/Self-Help Groups
and Group Counseling
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Support groups are more informal
and require the client to be
motivated to attend the meetings on
her own
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Group counseling may be done in
a more structured environment, or
even in a prenatal care setting
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It is organized by a health care
professional with knowledge of
evidence-based tobacco treatment
approaches
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Facilitated group counseling
improves people's ability to quit
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14% abstinence rate vs. 10.8% no
intervention
Self-help does not appear to have a
significant impact on reducing rates
of smoking among the general
population
US Public Health Service Clinical Practice
Guidelines, Treating Tobacco Use and
Dependence, 2000
Intra-treatment and Extra Treatment
Supportive Interventions
Intra-treatment Interventions
(within treatment setting)
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provider offers encouragement and belief in
user's ability to quit
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Provider communicates caring and concern,
is open to individual's expression of fears of
quitting and ambivalent feelings
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Tobacco user is encouraged to talk about the
quitting process (reasons to quit, previous
successes, difficulties encountered)
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The use of intra-treatment social support
yields a 14.4% abstinence rate
(Fiore et al. 2000)
Extra-treatment Interventions
(outside treatment setting)
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Tobacco user is offered skills training in soliciting
support from others (family, friends,
co-workers), is helped in establishing a
smoke-free home
Help lines and web resources are available
1-800 QUIT NOW
www.helppregnantsmokersquit.org
Tobacco user can use a buddy system (letters,
contracts, tip sheets) www.lungusa.org
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Extra-treatment social support yields a 16.2%
abstinence rate
(Fiore et al. 2000)