RWJF Scholar examines neighborhood-based death rates from opiate-based painkiller overdoses, compared with heroin overdose deaths.
From April 2000 through September 2005, project staff at the American College of Obstetricians and Gynecologists (ACOG) spearheaded an effort to establish the U.S. Public Health Service's smoking cessation guideline (the 5 A's), published in 2000, as a routine part of prenatal care for all pregnant women in the United States.
The Robert Wood Johnson Foundation (RWJF) supported this unsolicited project with a grant of $749,568.
In 1999, the Centers for Disease Control and Prevention (CDC) reported that 21 percent of American women smoked during pregnancy (CDC report, 2002). According to the U.S. Surgeon General's 2001 report:
In 2000, the U.S. Public Health Service (USPHS) published a best practice guideline for clinicians treating tobacco use and dependence, which includes pregnancy-specific information. The guideline is built around the 5 A's, a patient-centered model of behavioral counseling:
The American College of Obstetricians and Gynecologists (ACOG), with headquarters in Washington, is a nonprofit, professional educational organization that represents most of the nation's obstetricians and gynecologists (ob-gyns). ACOG actively promotes smoking-cessation interventions for women.
According to ACOG survey data, almost all ob-gyns ask their pregnant patients if they smoke and advise them to quit. Far fewer physicians take the next steps of assessing their patients' willingness to quit, assisting them and arranging for help.
When they do, the results are dramatic. According to a 2000 article in Tobacco Control (Melvin et al., 2000), physicians who spend five to 15 minutes counseling their pregnant patients and providing them with written self-help material can achieve 70 percent quit rates, compared to 30 percent for those who simply provide advice to quit.
In 1997, RWJF funded ACOG and four other large organizations of health care professionals to launch campaigns to inform their clinician members about the USPHS clinical practice guideline on smoking cessation and to help them integrate the interventions into their office practice. See Grant Results on ID# 030525 etc.
RWJF also created a national program called Smoke-Free Families: Innovations to Stop Smoking During and Beyond Pregnancy (see Grant Results). The program has been working to discover the best ways to help pregnant smokers quit and to spread the word about effective evidence-based treatments.
RWJF also has funded the dissemination efforts of the National Partnership to Help Pregnant Smokers Quit with two grants (ID#s 045257 and 053310) totaling $1,927,600. The National Partnership is a coalition of 55 government and private organizations that seeks to improve the health of this and future generations by increasing the number of pregnant smokers who quit smoking.
Through a nationwide effort to reach women, providers and communities, the National Partnership hopes to ensure that all pregnant women in the Unites States are screened for tobacco use and receive best practice cessation counseling as part of their prenatal care.
In addition, RWJF has funded the Addressing Tobacco in Managed Care program that supported evaluations of replicable efforts by managed care organizations to integrate effective tobacco-cessation interventions into everyday clinical practice and the basic health care they provide. See the Grant Results on the program.
This project was designed to capitalize on:
Project staff at ACOG had two grant objectives:
To achieve these objectives, staff:
See Results for details on educational and training materials produced and partnership activities.
See Appendix 1 for information about dissemination.
To oversee its activities on prenatal smoking cessation, ACOG formed a 12-member advisory committee, including ACOG members and liaisons from Smoke-Free Families and the Association of Women's Health and Obstetric and Neonatal Nurses.
ACOG reported the following project results, as of September 2005:
ACOG staff disseminated these educational tools through direct mailings, Web site listings, promotions by affiliated groups, and distribution at national and local meetings.
To institutionalize the 5 A's as part of routine prenatal care, ACOG staff:
In 2001, ACOG fielded a survey to more than 1,200 ob-gyns in Ohio. It assessed knowledge of smoking-cessation methods during pregnancy and barriers to integrating the 5 A's intervention into routine clinical practice.
According to an article by the project director in Nicotine & Tobacco Research (see the Bibliography for details):
ACOG staff surveyed 5,000 ob-gyns in 2004 to evaluate the impact of its strategies to improve awareness and implementation of the 5 A's.
Preliminary findings indicated that physicians had not implemented the 5 A's office protocols to the degree expected. As of the fall of 2006, project staff was analyzing the data and planned to publish an article on the results.
Staff members held a focus group with six ob-gyns in Chicago in June 2005 to explore obstacles to implementing the 5 A's. They reported the following findings to RWJF:
Participants made the following suggestions for improving smoking-cessation materials:
ACOG staff continues to showcase its educational and training materials at professional meetings and receives about 600 requests per month for copies. Staff members also serve on working committees of Smoke-Free Families and the National Partnership to Help Pregnant Smokers Quit.
As of September 2006, ACOG staff is pursuing these new or ongoing initiatives:
Disseminating the Best Practice Intervention for Smoking Cessation During Pregnancy
American College of Obstetricians and Gynecologists (Washington, DC)
Janet Chapin, R.N., M.P.H.
Dissemination of Educational Materials
Smoking Cessation During Pregnancy: A Clinician's Guide to Helping Pregnant Women Quit Smoking. As of September 2004:
Smoking Cessation During Pregnancy (ACOG Education Bulletin No. 260). Obstetrics & Gynecology, September 2000.
Smoking Cessation During Pregnancy (Committee Opinion No. 316). Obstetrics & Gynecology, October 2005.
Tobacco Partnership State Projects Supported by Minigrants
During the spring and summer of 2005, ACOG provided $1,000 minigrants to support the following activities:
Colorado Women's Tobacco Cessation Team
Funds were used to print and mail materials to promote the state's Prematurity Awareness Conference.
IOWA Women Against Nicotine and Tobacco (IWANT)
Funds supported a "lunch and learn" training in November 2005 for health care providers implementing a tobacco-cessation system-level change.
Minnesota State Team for Tobacco Cessation and Prevention for Women of Childbearing Age, including Pregnant Women
Funds helped support a one-day training on women and smoking cessation in January 2006. The training was available statewide via video conferencing to primary care practitioners, nurses, health educators, nutritionists, doulas (lay women who help with pregnancy and labor) and community health workers who provide services to pregnant women.
Nevada Tobacco-Free Babies Coalition
Funds were used to purchase 600 canvas tote bags as an incentive for pregnant women who quit smoking and remain tobacco free.
North Dakota Tobacco Partnership
Funds were used to print and distribute tobacco-cessation prescription pads that clinicians can use to give patients notes and recommendations for tobacco cessation. The pads include the phone number of a North Dakota quitline.
Ohio Women's Tobacco Cessation Partnership Team
Funds were used to purchase the patient workbook, "Need Help Putting Out That Cigarette?" and to distribute it to perinatal smoking-cessation projects within four high-risk counties.
Pennsylvania Women's Tobacco Prevention Team
Funds were used for interviews, surveys and focus groups to aid in developing appropriate messaging for smoking cessation kiosks in strategically targeted high-volume ob-gyn clinics.
Southern New Jersey Perinatal Cooperative—Mom's Quit Connection
Funds were used to purchase:
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
"Substance Use" in Précis: An Update in Obstetrics and Gynecology. Primary and Preventive Care, Third Edition. Washington: ACOG, 2004. Order book: $59, $49 for ACOG members.
"Smoking and Women's Health" in Special Issues in Women's Health. Washington: ACOG, 2005. Order book: $59, $45 for ACOG members.
ACOG Committee Opinion No. 316. "Smoking Cessation During Pregnancy." Obstetrics & Gynecology, 106(4): 883–888, 2005. (Reprint of report, see below.)
Chapin J and Root W. "Improving Obstetrician-Gynecologist Implementation of Smoking Cessation Guidelines for Pregnant Women: An Interim Report of the American College of Obstetricians and Gynecologists." Nicotine & Tobacco Research, 6(Suppl. 2): S253–S257, 2004. Available online.
Smoking Cessation During Pregnancy: A Clinician's Guide to Helping Pregnant Women Quit Smoking. Washington: ACOG, 2002. Order single copy free by emailing firstname.lastname@example.org. Include name, affiliation and mailing address.
Education package includes:
Smoking Cessation During Pregnancy. Committee Opinion No. 316. Washington: ACOG, October 2005. Order single copy free by emailing email@example.com. (Replaces Educational Bulletin No. 260, September 2000.)
Smoking Cessation During Pregnancy: A Clinician's Guide to Helping Pregnant Women Quit Smoking. PowerPoint presentation. Washington: American College of Obstetricians and Gynecologists, 2002. Available online. Also available as PDF file.
Smoking Cessation for Pregnancy and Beyond: Learn Proven Strategies to Help Your Patients Quit. "Virtual Clinic" CD-ROM. Lebanon, NH: Interactive Medial Library, Dartmouth Medical School, 2004. Download free from Dartmouth or order CD-ROM from ACOG for $25, plus shipping and handling.
"Smoking in Pregnancy: Clinical Perspectives." Washington: ACOG, fielded April 2001 in Ohio. Mailed to more than 1,200 ob-gyns.
"ACOG National Survey on Smoking Cessation During Pregnancy." Washington: ACOG, fielded August–September 2004. Mailed to 5,000 ACOG members nationwide.
"Perinatal Focus Group to Determine Barriers to Using Smoking Cessation Materials," held in conjunction with a June 2004 postgraduate course for ob-gyns in Chicago. Six ob-gyns participated.
www.acog.org. Web site of the American College of Obstetricians and Gynecologists provides access to information and resources for professionals and patient education materials on smoking cessation. Click "Women's Issues" and then "Smoking Cessation."
Report prepared by: Kelsey Menehan
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: C. Tracy Orleans
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