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

1. Racial/Ethnic Disparities in the Receipt of Smoking Interventions during Prenatal Care Analysis of the 2000-2001 Oregon Pregnancy Risk Assessment Monitoring Surveillance System Sarah-Truclinh T. Tran, BS Kenneth D. Rosenberg, MD, MPH Oregon Public Health Division Maternal and Child Health Epidemiology meeting December 7, 2006

2. Pregnancy: time to quit smoking • Pregnancy as a teachable moment • Women willing to change behavior • for the sake of the baby

3. Smoking During Pregnancy, Oregon • 1993-97: 18% of pregnant women reported smoking (birth certificate) • 1997: Oregon Tobacco Prevention Education Program began • Increased tobacco tax • Quit Line • Community activities to change culture • Decline in smoking began 1997 • 2003: 12%

4. Background: The Five A’s Intervention • ASK about her smoking status • ADVISE to quit with personalized messages • ASSESS her willingness to quit • ASSIST with skills building, self-help materials and social support • ARRANGE to follow-up during subsequent visits • Considered the “best practice” intervention for pregnant smokers by experts • CDC, Agency for Healthcare Research and Quality (AHRQ), Smoke-Free Families Program, American College of Obstetricians and Gynecologists (ACOG) • Increases quit rates by 30-70% when provided by PNC providers

5. Methods • Data collected from Jan 2000- Nov 2001; 72.6% unweighted response rate • Study population included women who smoked during first 3 months of pregnancy • Outcome variables were responses to questions about receipt of the Ask, Advise, and Assist (Three A’s) components of Five A’s

6. Results: Study Population Women who reported smoking during 1st trimester of pregnancy, by race/ethnicity (Oregon PRAMS, 2000-2001)

7. Results: Descriptive Analysis Smoking cessation interventions received during PNC among pregnant smokers, n= 594 (Oregon PRAMS, 2000-2001)

8. Results: Multivariate Model Multiple logistic regression models of Three A’s intervention (Oregon PRAMS, 2000-2001) a Weighted analyses 1 Controlled for income, residence setting (rural/urban), OHP insurance pre-pregnancy, WIC participation

9. Key Findings • Only 42% of pregnant smokers received optimal smoking cessation counseling • Race/ethnicity was a significant predictor of receiving the Three A’s • American Indian pregnant smokers were less likely to get optimal smoking cessation counseling. Why?

10. Discussion: Smoking Counseling Finding: Women’s smoking status identified, but inadequate assistance reported; consistent with:

11. Discussion: Racial Differences in the Receipt of Smoking Interventions Findings: Blacks1,amore likely, AI/AN1,aless likely to have recalled receiving Three A’s during PNC • Petitti et al. (1991): Blacks reported receiving less advice about alcohol, and more advice about smoking and drug use during PNCa • Kogan et al. (1994): Blacks 1.35 (95% CI: 1.21-1.5) times more likely to report NOT receiving smoking advice during PNCa • Houston et al. (2005): Blacks, Native Amer. were advised less frequently than Whites, in general health visits 1 non-Hispanic, a compared to non-Hispanic Whites

12. Quitting and Staying Quit • DHS Smoke Free Mothers and Babies program • Local health department prenatal care • Private prenatal care providers • Next step: help mothers stay quit • Work with mothers’ partners

13. Public Health Implications • There is a need to improve the training of PNC providers so they can help pregnant women stop smoking. • The need for this training may be most urgent among PNC providers who care for Native American women.

14. Future Research Directions • What are barriers to providers offering the Assist component of Five A’s? • What are reasons that non-Hispanic AI/AN women are not receiving optimal smoking cessation counseling? • PNC provider type • Rural vs. urban residence • What is frequency of women quitting and staying quit after receiving optimal smoking intervention?