Online Program

Nurse and Midwife Delivered Prenatal Smoking Cessation Intervention in Rural Appalachia

Sunday, November 1, 2015

Ilana R A Chertok, PhD, MSN, RN, IBCLC, School of Nursing, West Virginia University, Morgantown, WV
Background: Women in rural Appalachia face health disparities, challenges of access to care, and poor maternal-infant health outcomes. West Virginia (WV) has the highest prenatal smoking prevalence rates in the nation. Limited evaluation of evidence-based smoking cessation interventions conducted by nurses working with women in rural Appalachia has been published. The purpose of the study was to evaluate the delivery of the ACOG 5As intervention by a trained team of midwives and nurse researchers.

Method: Prospective evaluation of the implementation of the 5As intervention for 35 women in four rural WV counties who smoked during pregnancy. Midwives initiated 5As during prenatal care and nurse researchers called monthly to provide encouragement, advice, and cessation strategies. Surveys included self-reported smoking behaviors at baseline, one month post-intervention, two months post-intervention, and postpartum.

Results: Post-intervention smoking rates and levels improved compared to baseline: 91% decreased and 9% quit smoking. Using repeated measures ANOVA, average number of cigarettes decreased from 10 cigarettes at baseline to 8 at one month, 7 at two months, and 6 by delivery (p=0.002). The women further reduced their tobacco exposure by enforcing indoor smoking restrictions. The percent of women with indoor smoking restrictions increased from 46% at baseline, to 55% at one month, 57% at two months, and 93% by delivery (p=0.001).

Conclusions: The incorporation of the evidence-based 5As intervention into prenatal care delivered by midwives and nurses to women living in rural WV facilitated decreased prenatal smoking rates and frequency thereby decreasing maternal and fetal smoking exposure.

Learning Areas:

Public health or related nursing

Learning Objectives:
Discuss the implementation of the 5As smoking cessation intervention for prenatal care of women living in rural communities.

Keyword(s): Prenatal Care, Tobacco Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted the study as the PI and was awarded a research grant for the study. I trained the midwife and nurse research team, engaged in and supervised the intervention, conducted the data analysis, and evaluated the program implementation. Prenatal smoking in rural communities is one of my research areas of focus in maternal-infant health care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.