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Racial/Ethnic Disparities in the Receipt of Smoking Cessation Interventions During Prenatal Care

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Abstract

To explore racial/ethnic disparities in the receipt of optimal smoking cessation counseling during prenatal care. We used data from Oregon’s perinatal surveillance system, the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) from 2000 to 2001. A stratified random sample of postpartum women were asked questions about events before, during and after pregnancy, including smoking and provision of smoking cessation counseling. The weighted response rate was 78.8% (n = 3,895). Receipt of a clinician protocol for smoking cessation intervention, called the Five A’s (Ask, Advise, Assess, Assist, Arrange), was the outcome of interest. In the Oregon PRAMS survey, we asked women about three of the Five A’s (Ask, Advise, Assist). Of 594 first trimester pregnant smokers, the majority were asked and advised about smoking by a prenatal care provider. However, a substantial proportion of women did not receive assistance to quit and only 42.2% received all three steps. Significant racial/ethnic variations were found only in the Assist step. Compared to non-Hispanic (NH) White women, NH American Indian women had lower odds (adjusted odds ratio [ORa]: 0.45; 95% confidence interval [95% CI] 0.24, 0.85) of receiving all three steps. In contrast, NH Black women had increased odds of receiving all three steps (ORa: 2.43; 95% CI 1.16, 5.10). We conclude that there is a need for prenatal care providers to address tobacco use, especially to Assist quitting, with all pregnant smokers. Healthcare systems should implement system prompts and supports for providers to remind them to address tobacco use with pregnant smokers.

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Acknowledgments

The authors thank Alfredo Sandoval and Tina Kent for their work with Oregon PRAMS, and Mark Nichols, Laurin Kasehagen and Dayna Kirk Morrison for their contributions. They also thank Catherine L. Rohweder for her thoughtful editorial comments. For their support of the Oregon PRAMS, the authors acknowledge the Maternal and Child Health Bureau and the Centers for Disease Control of the U.S. Department of Health and Human Services.

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Authors and Affiliations

  1. Department of Public Health and Preventive Medicine, Oregon Health & Sciences University, Portland, OR, USA

    Sarah-Truclinh T. Tran

  2. Office of Family Health, Oregon Public Health Division, 800 NE Oregon Street, Suite 850, Portland, OR, 97232, USA

    Kenneth D. Rosenberg

  3. Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA

    Nichole E. Carlson

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  1. Sarah-Truclinh T. Tran
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  2. Kenneth D. Rosenberg
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Correspondence to Kenneth D. Rosenberg.

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Tran, ST.T., Rosenberg, K.D. & Carlson, N.E. Racial/Ethnic Disparities in the Receipt of Smoking Cessation Interventions During Prenatal Care. Matern Child Health J 14, 901–909 (2010). https://doi.org/10.1007/s10995-009-0522-x

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