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Nicotine & Tobacco Research Advance Access published online on March 23, 2009
Nicotine & Tobacco Research, doi:10.1093/ntr/ntn035
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© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Targeting pregnant and parental smokers: Long-term outcomes of a practice-based intervention

Deborah R. Moss, Patricia A. Cluss, Margaret Watt-Morse and Francis Pike

Deborah R. Moss, M.D., M.P.H., Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
Patricia A. Cluss, Ph.D., Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
Margaret Watt-Morse, M.D, M.P.H., Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
Francis Pike, B.Sc., M.Sc., Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA

Corresponding Author: Deborah R. Moss, M.D., M.P.H., Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, 3705 5th Avenue, Pittsburgh, PA 15213, USA. Telephone: 412-692-7929. Fax: 412-692-8516. Email: deborah.moss{at}chp.edu


  Abstract

Introduction: This study aimed to assess the change in obstetric and pediatric provider smoking cessation practices following implementation of a practice guideline–driven office-based program.

Methods: This pre–post evaluation took place between May 2003 and August 2006 in 1 pediatric and 1 obstetric hospital-based clinic. The intervention involved provider training combined with office system supports. A total of 1,080 exit interviews were collected to measure outcomes of clinic practices at baseline and at 1 month, 6 months, 1 year (obstetric), and 2 years (pediatric) after implementation. Trend analysis was used to assess change in practice rates over time.

Results: Following program implementation, pediatric provider "Ask" rates increased (49% before to 86% 2 years after, p < .0001); changes in pediatric "Advise" and "Assist" rates were not significant: 44%–59% (p = .19) and 18%–28% (p = .26), respectively. In the obstetric clinic, whereas no significant changes were detected in provider "Ask" (59%–65% 1 year after, p = .17) or "Advise" (72%–85%, p = .27) rates, "Assist" rates rose from 28% to 62% (p = .0075) 1 year after program implementation.

Discussion: Implementation of the office-based program achieved significantly improved trends in pediatric provider "Ask" rates and obstetric provider "Assist" rates over time. Further research is needed on office strategies to create long-term provider behavior changes in smoking cessation practices.

Received: January 15, 2008; Accepted: September 18, 2008
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