This provides a discouraging view of the smoking-cessation activities
of the agencies that serve pregnant women, says Lorraine Klerman, Dr.P.H,
of Brandeis University. Agency staff members believe that pregnant women
have more important problems than smoking. They feel that it is difficult
if not impossible to convince pregnant women to stop smoking, and lack
materials to help them do so.
In a study appearing in the American Journal of
Preventive Medicine, Klerman
and Crystal Spivey, Dr.P.H, of the University of Alabama at Birmingham
surveyed 354 public and quasi-public organizations that offered prenatal
care, especially to low-income women.
According to the U.S. Public Health Service, women who smoke are likely
to have more stillbirths, spontaneous abortions, and premature babies
compared to non-smokers. Their babies are also more likely to have lower
birth weight,
sudden infant death syndrome, cleft palate and childhood cancers. Helping
women quit smoking when they’re pregnant can benefit the future
health of their children.
The organizations surveyed offered care both at clinics and by visiting
women in their homes. They included federally funded Healthy Start programs
and a variety of maternal and child health programs run by states and cities
around the United States.
Only 24 percent of the agencies thought they were doing an adequate
job of getting women to stop smoking. Most of those who acknowledged
they weren’t
doing a good enough job cited insufficient agency funds and lack of staff
time as reasons. Others said that clients had more important problems
to worry about. About a third blamed a shortage of specialists to train
staff.
Only a quarter of the programs offered smoking cessation classes, but
most of those said it was hard to get clients in the door. They attributed
this to lack of encouragement from clients' family members, lack of child
care, long waiting lists and inconvenient hours or locations.
Agencies also asked for more smoking cessation materials, guidelines for
proven ways to combat smoking and training at professional meetings.
Most agencies that visited pregnant women in their homes required staff
to record their clients' smoking status and expected them to counsel pregnant
smokers about the effects of smoking. However, less than half the agencies
said they trained the home visitors in smoking reduction or cessation methods.
Client problems like drug addiction or domestic violence ranked higher
on these workers priority lists.
All individuals and groups serving pregnant women need to direct more
effort to helping smokers quit, Klerman says. They need experts to educate
staff, pregnancy-specific smoking materials, manuals of best practices
and changes in agency policies
She suggests making smoking education programs part of every staff orientation
program and requiring agency workers to record pre-pregnancy smoking status
and inquire about other smokers in the household.
Clearly more research is needed, Klerman says, not only about how to convince
pregnant women to stop smoking but also about how to convince clinicians
to use methods known to be effective.
Grants from the Robert Wood Johnson Foundation and the Maternal and Child
Health Bureau of the U.S. Department of Health and Human Services supported
the research.
