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U.S. Department of Health and Human Services Centers for Disease Control and Prevention Tobacco Cessation During Pregnancy: Prevalence and Interventions Van Tong, MPH Epidemiologist, CDC Division of Reproductive Health October 21, 2009 CDC Division of Reproductive Health (DRH)
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Centers for Disease Control and Prevention
Tobacco Cessation During Pregnancy: Prevalence and Interventions Van Tong, MPHEpidemiologist, CDC Division of Reproductive HealthOctober 21, 2009
Our mission is to promote optimal reproductive and infant health and quality of life by influencing public policy, health care practice, community practices, and individual behaviors through scientific and programmatic expertise, leadership, and support.
Prenatal smoking is one of the most common preventable causes of poor birth outcomes
Smoking among women causes
Second hand smoke (SHS) exposure
Source: Surgeon General’s Report: The Health Consequences of Smoking, 2004
However, data suggest an increased risk of
Low birth weight
Health effects (2)
2003 revised birth
* Source: Birth certificates, National Center for Health Statistics; excludes California. Not all states had data for the entire observation period
* Source: Birth certificates, National Center for Health Statistics; excludes California.
State-specific range was 3.5% (DC) to 26.1% (WV).
Source: CDC SAMMEC: http://apps.nccd.cdc.gov/sammec/
* AK, AR, CO, FL, GA, HI, IL, ME, MD, MI, MN, NE, NJ, NM, NY (includes NYC), NC, OH, OK. OR, RI, SC, UT, VT, WA, WV
* Smoking ascertained from PRAMS and linked birth certificate. AK, AR, CO, FL, GA, HI, IL, ME, MD, MI, MN, NE, NJ, NM, NY (includes NYC), NC, OH, OK. OR, RI, SC, UT, VT, WA, WV
* On average 4 months after delivery. AK, AR, CO, FL, GA, HI, IL, ME, MD, MI, MN, NE, NJ, NM, NY (includes NYC), NC, OH, OK. OR, RI, SC, UT, VT, WA, WV
1 CDC. Smoking during pregnancy--United States, 1990-2002. MMWR. 2004 Oct 8;53(39):911-5.
2 Gavin et al. Sexual and reproductive health of persons aged 10-24 years - United States, 2002-2007. MMWR Surveill Summ. 2009 Jul 17;58(6):1-58.
Source: Kim et al. Patterns of Cigarette and Smokeless Tobacco Use Before, During, and After Pregnancy Among Alaska Native and White Women in Alaska, 2000–2003. Matern Child Health J. 2009 Jan 13.
Fiore et al., http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.chapter.28163
Ask about tobacco use. Identify and document tobacco use status for every patient at every visit.
Adviseto quit. In a clear, strong and personalized manner urge every tobacco user to quit. Quitting early in pregnancy provides the greatest benefit to the fetus
Assess willingness to make a quit attempt. Is the tobacco user willing to make a quit attempt at this time?
Assistin quit attempt. For the patient willing to make a quit attempt, offer medication and provide or refer for counseling or additional treatment to help the patient quit.For patients unwilling to quit at the time, provide interventions designed to increase future quit attempts.
Arrangefollowup. For the patient willing to make a quit attempt, arrange for follow-up contacts, beginning within the first week after the quit date.For patients unwilling to make a quit attempt at the time, address tobacco dependence and willingness to quit at next clinic visit.
Fiore et al, 2008
Evidence suggests that telephone counseling is effective, especially for
light smokers (<10 cig a day) and
for women who have already attempted to quit
(McBride et al study AJPH 1999; Rigotti et al study Obstet & Gyn 2006;CA evaluation of quitlines among pregnant smokers)
*CDC. State Medicaid coverage for tobacco-dependence treatments--United States, 2006.
MMWR 2008 Feb 8;57(5):117-22. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5705a2.htm
For clinicians and public health practitioners
Tobacco Use and Pregnancy Website: