Promoting Evidence Based Smoking Cessation Interventions for Women Before, During, and After Pregnancy

[摘要]

The American Public Health Association,

Recognizing that cigarette smoking by women of reproductive age is a major cause of reproductive health problems, and is associated with a higher risk of infertility and pregnancy complications¹; and that approximately 31% of females between the ages of 15 and 44 smoke cigarettes²;

Recognizing that smoking during pregnancy is associated with a higher risk of preterm delivery, stillbirth, neonatal mortality, perinatal mortality, and is a significant cause of low birthweight¹; and that the costs of neonatal and maternal conditions attributable to smoking during pregnancy in the U.S. range from $502 to $534 million per year^3,4;

Recognizing that the prevalence of smoking among pregnant women ranges from 17.8% to 21.5%, including subpopulations of women with disproportionately high prevalence rates1; and that birth certificate data show that 12.3% of women who had a live birth smoked during pregnancy⁵;

Recognizing that smoking after pregnancy is associated with a higher risk of infant death from SIDS and a higher risk of not breastfeeding^1,6; and that approximately 50% of women who quit smoking during pregnancy return to smoking post-partum⁷;

Recognizing that stopping smoking before pregnancy and staying quit after pregnancy confers health benefits to women of reproductive age, who have many years of potential life left, as well as their children¹;

Noting that brief interventions, intensive interventions, and first-line pharmacotherapies are effective for adult women of many ethnic groups⁸;

Noting that pregnancy-specific smoking cessation interventions can increase the rate of quitting by 30-70% over no intervention^8,9; that these brief interventions have been standardized into a generic tobacco treatment approach^8,10; and that tobacco treatment for pregnant women is cost effective^11-13;

Noting that some preganant women also use smokeless tobacco and should receive the same best practice interventions as those women who smoke cigarettes;

Noting that more effective interventions for women who smoke heavily and for women who stop smoking during pregnancy but relapse post-partum need to be developed and evaluated;

Noting that federal agencies recommend that health care professionals and systems provide evidence-based tobacco treatment services for pregnant women^8,14; and yet a national survey of obstetrician/gynecologists revealed that only 58.6% report always assisting their patients in developing a plan to quit smoking, and only 37.6% report always providing self-help materials¹⁵;

Noting that there are provider-level and system-level barriers to delivering smoking cessation interventions;

Noting that full coverage of tobacco treatments by health plans, including reimbursement for counseling and pharmacotherapies, can lead to increased use of cessation services by consumers who smoke, as well as increased quit rates and quit atttempts^16,17;

Recognizing that population-based programs and policies that change the smoker’s environment, such as increasing the relative price of tobacco through taxes, reducing the density of outlets where tobacco is sold or distributed, reducing the locations where smoking is allowed and exposure to second hand smoke, are also of great importance in promoting and supporting cessation¹⁸;

Noting that the American Public Health Association has issued policy statements in support of smoking cessation programs^19-23; 

Pleased that the Surgeon General considers smoking cessation among women to be of high priority¹; and the Healthy People 2010 goal is to reduce smoking among pregnant women to less than 1%²⁴;

Noting that there are new coalitions of government agencies, non-profit organizations, and businesses being formed to broaden the support for smoking cessation services for women of reproductive age, such as the National Partnership to Help Pregnant Smokers Quit²⁵;

APHA therefore

1. Recommends that all health care professionals and programs that serve women adopt evidence-based interventions such as those highlighted in the U.S. Public Health Service Clinical Practice Guideline, “Treating Tobacco Use and Dependence,” which includes health education and health promotion activities⁸;
2. Advocates that government agencies, foundations, insurers and other funders provide incentives and support changes at all appropriate levels of the health care system so that women’s health care professionals and programs can universally and systematically implement tobacco dependence treatment;
3. Urges funders to support and researchers to conduct research to improve implementation of evidence-based smoking cessation interventions for women of reproductive age, including populations known to have a disproportionately high rate of smoking;
4. Encourages funders to support and researchers to identify and evaluate safe and effective interventions for adolescents and women who are not benefiting from the current best practice;
5. Calls on public and private health care purchasers and insurers to provide full coverage of tobacco treatment services for pregnant women and women of reproductive age; 
6. Calls on federal, state, and local governments, and other public and private agencies to explore options for financing the above-recommended activities.

References

1. Women and Smoking: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001.
2. Summary of Findings from the 2000 National Household Survey on Drug Abuse. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2001: Table 6.27A Estimated Numbers (in Thousand) of Past Month Users of Cigarettes Among Females Aged 15 to 44, by Pregnancy Status and Demographic Characteristics: Annual Averages Based on 1999 and 2000 Samples.
3. Adams EK, Melvin CL. Costs of maternal conditions attributable to smoking during pregnancy. Am J Prev Med. 1998;15:212-219.
4. Adams EK, Miller VP, Ernst C, Nishimura BK, Melvin C, Merritt R. Neonatal health care costs relating to smoking during pregnancy. Health Econ. 2002;11:193-206. 
5. Matthews TJ. Smoking during pregnancy in the 1990s. Natl Vital Stat Rep. 2001;49(7).
6. Pollack HA. Sudden infant death syndrome, maternal smoking during pregnancy, and the cost-effectiveness of smoking cessation intervention. Am J Public Health. 2001;91:432-436.
7. Carmichael SL, Ahluwalia IB. Correlates of postpartum smoking relapse: results from the Pregnancy Risk Assessment Monitoring System (PRAMS). Am J Prev Med. 2000;19:193-196.
8. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 2000. 
9. Mullen PD. Maternal smoking during pregnancy and evidence-based intervention to promote cessation. In: Spangler JG, ed. Primary Care: Clinics in Office Practice (tobacco use and cessation). Philadelphia, PA: WB Saunders. 1999;26:577-589.
10. ACOG Educational Bulletin #260, “Smoking Cessation During Pregnancy.” American College of Obstetricians and Gynecologists, September 2000.
11. Windsor RA, Lowe JB, Perkins, LL, Smith-Yoder D, Artz L, Crawford M, et al. Health education for pregnant smokers: its behavioral impact and cost benefit. Am J Public Health. 1993;83:201-206.
12. Windsor RA, Woodby Lesa L, Miller TM, Hardin JM, Crawford MA, DiClemente CC. Effectiveness of Agency for Health Care Policy and Research clinical practice guideline and patient education methods for pregnant smokers in Medicaid maternity care. Am J Obstet Gynecol. 2000;182:68-75.
13. Broskowski A, Smith S. Estimating the Cost of Preventive Services in Mental Health and Substance Abuse Under Managed Care. DHHS Pub. No. SMA-02-3617R. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2001.
14. Dorfman S. Preventive interventions under managed care: Mental health and substance abuse services. DHHS Publication No. SMA-00-3437. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 2000.
15. Floyd R, Belodoff B, Sidhu J, Schulkin J, Ebrahim S, and Sokil R. A survey of obstetrician-gynecologists on their patients’ use of tobacco and other drugs during pregnancy. Prenat Neonatal Med. 2001;6:201-207.
16. Curry SJ, Grothaus LC, McAfee T, Pabiniak C. Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. N Engl J Med. 2000;339:673-679.
17. Schauffler HH, McMenamin S, Olson K, Boyce-Smith G, Rideout JA, Kamil J. Variations in treatment benefits influence smoking cessation: results of a randomized controlled trial. Tob Control. 2001;10:175-180.
18. National Cancer Institute. Population Based Smoking Cessation: Proceedings of a Conference on What Works to Influence Cessation in the General Population. Smoking and Tobacco Control Monograph No.12. NIH Publication No. 00-4892. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, November 2000. 
19. APHA Policy Statement 9808: National Tobacco Control Legislation. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: American Public Health Association; 1998.
20. APHA Public Policy Statement 9301: Environmental Tobacco Smoke. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: American Public Health Association; 1993.
21. APHA Public Policy Statement 9302: Tobacco-Free Schools. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: American Public Health Association; 1993.
22. APHA Public Policy Statement 9118: Reducing Smoking in Prisons and Jails. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: American Public Health Association; 1991.
23. APHA Public Policy Statement 9019: Not Targeting Women in Smoking Ads. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: American Public Health Association; 1990.
24. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, 2000: Objective 16-17c.
25. Smoke-Free Families National Dissemination Office. The National Partnership to Help Pregnant Smokers Quit: Action Plan. May, 2002. http://www.smokefreefamilies.org/fororgs.html.

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[发布日期] 2002-11-13

[学科分类] 医学（综合）