Smoking Cessation for Pregnancy and Beyond: Virtual Clinic Companion Slides - PowerPoint PPT Presentation


Title: Smoking Cessation for Pregnancy and Beyond: Virtual Clinic Companion Slides


1
Smoking Cessation for Pregnancy and
BeyondVirtual Clinic Companion Slides
  • Catherine A. Powers, EdD, LSW
  • PACE Tobacco Prevention and
  • Cessation Education
  • for Medical School Students
  • Boston University School of Medicine
  • Funded by NCI R25-CA9 1958-04

2
Smoking Mortality and Morbidity in the United
States
  • Smoking is the single most preventable cause of
    deaths in the United States
  • Smoking-related disease and complications account
    for 450,000 deaths each year in the United States
  • It is estimated that between 12 and 20 of
    pregnant women in the US smoke
  • Association of Womens Health Obstetric
    and Neonatal Nurses, 2002
  • Martin, J.A., et al. Births Final Data for
    2002. National Vital Statistics Reports, volume
    52,
  • number 10, Dec. 2003.

3
Smoking and Womens Unique Risks
  • All smokers are at risk of heart disease, stroke,
    cancer and pulmonary disease
  • Women have additional risks related to menstrual
    and reproductive functions
  • - Increased risk of conception delay at primary
    and secondary infertility
  • - Increased risk of ectopic pregnancy and
  • spontaneous abortion
  • - Earlier menopause with more severe symptoms
  • US Department of Health and Human Services, The
    Health Consequences of Smoking A Report of the
    Surgeon General (2004)

4
The Risks of Smoking During Pregnancy
  • Premature rupture of the membranes
  • Abruptio placentae
  • Preterm delivery
  • Smoking during pregnancy accounts for
  • 20 of Low birth weight babies
  • 8 of pre-term deliveries
  • 5 of prenatal deaths
  • US Department of Health and Human Services,
    Surgeon Generals Report 2001 Women and Smoking

5
The Benefits of Quitting
  • Women who quit smoking before or during pregnancy
    reduce the risk for adverse reproductive
    outcomes, including
  • conception delay
  • infertility
  • premature rupture of membranes
  • preterm delivery
  • low birth weight
  • US Department of Health and Human Services,
    Surgeon Generals Report 2001 Women and Smoking

6
Quitting during Pregnancy
  • A higher percentage of women stop smoking during
    pregnancy, both spontaneously and with assistance
    than at other times in their lives.
  • Using pregnancy-specific programs can increase
    smoking cessation rates, which benefits infant
    health and is cost effective.
  • Within 6 months of delivery women who quit
    smoking immediately after learning they are
    pregnant (spontaneous quitters) have a 70
    relapse rate
  • Smoking Cessation in Pregnancy A Review of
    Postpartum Relapse Prevention Strategies
  • J Am Board Fam Pract 17(4)264-275, 2004.
  • US Department of Health and Human Services,
    Surgeon Generals Report 2001 Women and Smoking

7
Pharmacotherapy and the Pregnant Smoker
  • The efficacy of nicotine replacement therapy in
    pregnancy is not known
  • The only completed and published randomized
    controlled trial of nicotine replacement
    (delivered by transdermal patches) showed no
    difference from placebo, but the numbers studied
    were small, and the trial was underpowered to
    determine whether nicotine replacement was
    effective.
  • Researchers did find that babies born to women in
    the nicotine treatment group had significantly
    higher birth weights than those in the placebo
    group indicating that the intrauterine growth
    restriction caused by smoking is probably not
    attributable to nicotine.
  • More research is needed to determine the effects
    of nicotine replacement therapy on pregnant women
    and their offspring.
  • Nicotine replacement therapy in pregnancy
    BMJ  2004328965-966 

8
Tobacco Cessation Programs
  • Women are more likely than men to use intensive
    treatment programs.
  • Women have a stronger interest than men in
    smoking cessation groups that offer mutual
    support through a buddy system and in treatment
    meetings over a long period.
  • US Department of Health and Human Services,
    Surgeon Generals Report 2001
  • Women and Smoking

9
Smoking Cessation Groups
  • There are two types of smoking cessation groups
    that are discussed in the literature
  • Support groups also labeled self-help groups
  • Group counseling with a trained facilitator

10
Support/Self-Help Groups and Group Counseling
  • Support groups are more informal and require the
    client to be motivated to attend the meetings on
    her own
  • Self-help does not appear to have a significant
    impact on reducing rates of smoking among the
    general population
  • US Public Health Service Clinical Practice
    Guidelines, Treating Tobacco Use and Dependence,
    2000
  • Group counseling may be done in a more structured
    environment, or even in a prenatal care setting
  • It is organized by a health care professional
    with knowledge of evidence-based tobacco
    treatment approaches
  • Facilitated group counseling improves people's
    ability to quit
  • 14 abstinence rate vs. 10.8 no intervention

11
Intra-treatment and Extra Treatment Supportive
Interventions
  • Intra-treatment Interventions
  • (within treatment setting)
  • provider offers encouragement and belief in
    user's ability to quit
  • Provider communicates caring and concern, is open
    to individual's expression of fears of quitting
    and ambivalent feelings
  • Tobacco user is encouraged to talk about the
    quitting process (reasons to quit, previous
    successes, difficulties encountered)
  • The use of intra-treatment social support yields
    a 14.4 abstinence rate
  • (Fiore et al. 2000)
  • Extra-treatment Interventions
  • (outside treatment setting)
  • Tobacco user is offered skills training in
    soliciting support from others (family, friends,
  • co-workers), is helped in establishing a
  • smoke-free home Help lines and web
    resources are available
  • 1-800 QUIT NOWwww.helppregnantsmokersquit.
    org
  • Tobacco user can use a buddy system
    (letters, contracts, tip sheets) www.lungusa.org
  • Extra-treatment social support yields a 16.2
    abstinence rate
  • (Fiore et al. 2000)
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Smoking Cessation for Pregnancy and Beyond: Virtual Clinic Companion Slides

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Title: Smoking Cessation for Pregnancy and Beyond: Virtual Clinic Companion Slides


1
Smoking Cessation for Pregnancy and
BeyondVirtual Clinic Companion Slides
  • Catherine A. Powers, EdD, LSW
  • PACE Tobacco Prevention and
  • Cessation Education
  • for Medical School Students
  • Boston University School of Medicine
  • Funded by NCI R25-CA9 1958-04

2
Smoking Mortality and Morbidity in the United
States
  • Smoking is the single most preventable cause of
    deaths in the United States
  • Smoking-related disease and complications account
    for 450,000 deaths each year in the United States
  • It is estimated that between 12 and 20 of
    pregnant women in the US smoke
  • Association of Womens Health Obstetric
    and Neonatal Nurses, 2002
  • Martin, J.A., et al. Births Final Data for
    2002. National Vital Statistics Reports, volume
    52,
  • number 10, Dec. 2003.

3
Smoking and Womens Unique Risks
  • All smokers are at risk of heart disease, stroke,
    cancer and pulmonary disease
  • Women have additional risks related to menstrual
    and reproductive functions
  • - Increased risk of conception delay at primary
    and secondary infertility
  • - Increased risk of ectopic pregnancy and
  • spontaneous abortion
  • - Earlier menopause with more severe symptoms
  • US Department of Health and Human Services, The
    Health Consequences of Smoking A Report of the
    Surgeon General (2004)

4
The Risks of Smoking During Pregnancy
  • Premature rupture of the membranes
  • Abruptio placentae
  • Preterm delivery
  • Smoking during pregnancy accounts for
  • 20 of Low birth weight babies
  • 8 of pre-term deliveries
  • 5 of prenatal deaths
  • US Department of Health and Human Services,
    Surgeon Generals Report 2001 Women and Smoking

5
The Benefits of Quitting
  • Women who quit smoking before or during pregnancy
    reduce the risk for adverse reproductive
    outcomes, including
  • conception delay
  • infertility
  • premature rupture of membranes
  • preterm delivery
  • low birth weight
  • US Department of Health and Human Services,
    Surgeon Generals Report 2001 Women and Smoking

6
Quitting during Pregnancy
  • A higher percentage of women stop smoking during
    pregnancy, both spontaneously and with assistance
    than at other times in their lives.
  • Using pregnancy-specific programs can increase
    smoking cessation rates, which benefits infant
    health and is cost effective.
  • Within 6 months of delivery women who quit
    smoking immediately after learning they are
    pregnant (spontaneous quitters) have a 70
    relapse rate
  • Smoking Cessation in Pregnancy A Review of
    Postpartum Relapse Prevention Strategies
  • J Am Board Fam Pract 17(4)264-275, 2004.
  • US Department of Health and Human Services,
    Surgeon Generals Report 2001 Women and Smoking

7
Pharmacotherapy and the Pregnant Smoker
  • The efficacy of nicotine replacement therapy in
    pregnancy is not known
  • The only completed and published randomized
    controlled trial of nicotine replacement
    (delivered by transdermal patches) showed no
    difference from placebo, but the numbers studied
    were small, and the trial was underpowered to
    determine whether nicotine replacement was
    effective.
  • Researchers did find that babies born to women in
    the nicotine treatment group had significantly
    higher birth weights than those in the placebo
    group indicating that the intrauterine growth
    restriction caused by smoking is probably not
    attributable to nicotine.
  • More research is needed to determine the effects
    of nicotine replacement therapy on pregnant women
    and their offspring.
  • Nicotine replacement therapy in pregnancy
    BMJ  2004328965-966 

8
Tobacco Cessation Programs
  • Women are more likely than men to use intensive
    treatment programs.
  • Women have a stronger interest than men in
    smoking cessation groups that offer mutual
    support through a buddy system and in treatment
    meetings over a long period.
  • US Department of Health and Human Services,
    Surgeon Generals Report 2001
  • Women and Smoking

9
Smoking Cessation Groups
  • There are two types of smoking cessation groups
    that are discussed in the literature
  • Support groups also labeled self-help groups
  • Group counseling with a trained facilitator

10
Support/Self-Help Groups and Group Counseling
  • Support groups are more informal and require the
    client to be motivated to attend the meetings on
    her own
  • Self-help does not appear to have a significant
    impact on reducing rates of smoking among the
    general population
  • US Public Health Service Clinical Practice
    Guidelines, Treating Tobacco Use and Dependence,
    2000
  • Group counseling may be done in a more structured
    environment, or even in a prenatal care setting
  • It is organized by a health care professional
    with knowledge of evidence-based tobacco
    treatment approaches
  • Facilitated group counseling improves people's
    ability to quit
  • 14 abstinence rate vs. 10.8 no intervention

11
Intra-treatment and Extra Treatment Supportive
Interventions
  • Intra-treatment Interventions
  • (within treatment setting)
  • provider offers encouragement and belief in
    user's ability to quit
  • Provider communicates caring and concern, is open
    to individual's expression of fears of quitting
    and ambivalent feelings
  • Tobacco user is encouraged to talk about the
    quitting process (reasons to quit, previous
    successes, difficulties encountered)
  • The use of intra-treatment social support yields
    a 14.4 abstinence rate
  • (Fiore et al. 2000)
  • Extra-treatment Interventions
  • (outside treatment setting)
  • Tobacco user is offered skills training in
    soliciting support from others (family, friends,
  • co-workers), is helped in establishing a
  • smoke-free home Help lines and web
    resources are available
  • 1-800 QUIT NOWwww.helppregnantsmokersquit.
    org
  • Tobacco user can use a buddy system
    (letters, contracts, tip sheets) www.lungusa.org
  • Extra-treatment social support yields a 16.2
    abstinence rate
  • (Fiore et al. 2000)
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