Racial/ethnic disparities in the receipt of smoking cessation interventions during prenatal care

Background: A smoking cessation protocol called the Five A's (Ask, Advice, Assess, Assist, Arrange) has been shown to increase quit rates by 30-70% among pregnant smokers when delivered by a prenatal care (PNC) provider. There is evidence that patients from racial/ethnic minority groups do not receive adequate health promotion counseling, including about smoking, during PNC as compared to patients from the majority white population.

Methods: Weighted logistic regression was performed on data from the 2000-2001 Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) that collects information about whether women received three of the Five A's (Ask, Advice, and Assist; the Three A's) during PNC. The unweighted response rate was 72.6% (N= 3,895). The study population comprised of first-trimester pregnant smokers.

Results: Of the 594 pregnant smokers, only 42.2% of them reported receiving the Three A's. Smoking counseling was not offered uniformly across race/ethnic groups. Despite having the highest smoking prevalence, Native American women were 0.45 times as likely (95% CI: 0.24, 0.85) as Whites to recall having received the Three A's (in a multivariate logistic model). In contrast, Blacks were 2.43 times more likely (95% CI: 1.16, 5.10) than Whites. The relationships remained statistically significant after controlling for socioeconomic factors.

Conclusions: Most pregnant smokers of all races did not receive adequate assistance to quit, indicating that there is a need to improve the training of PNC providers to address tobacco dependency. The need for this training may be most urgent in providers who care for Native American women.