Paper
Thursday, 20 July 2006
This presentation is part of : Using Evidence to Enhance Patient Care
Healthcare System Changes and Smoking Cessation in a Rural Perinatal Population
Geraldine R. Avidano Britton, RN, FNP, PhD, Decker School of Nursing, Binghamton University, Binghamton, NY, USA
Learning Objective #1: describe changes in health care systems that are needed to implement smoking cessation programs in a perinatal setting.
Learning Objective #2: discuss the importance of the use of biomarkers, such as cotinine, in nurse-managed clinical trials.
Changes in health care systems are necessary in order to implement best practices in tobacco cessation. The purposes of this study were to 1) examine the effectiveness of a nurse-managed smoking cessation program that was integrated into the “real world” of routine perinatal care in a rural population, and 2) to determine the discordance between self-reported smoking status and urinary cotinine assays. Program implementation entailed changes in the systems of seven private offices and one inpatient medical center in upstate New York.  A convenience sample of 194 women (mean age, 23.7 years; average education level, 12.2 years; 94.8 % ethnically White; 73.2% single, separated or divorced; and 56.2% Medicaid funded) who stated that they were smokers at the onset of their pregnancies were enrolled in “usual care” (94) and intervention (101) groups. There were no differences between groups in subject characteristics or baseline smoking data. Smoking status was measured by self-report and urinary cotinine at four points during pregnancy and postpartum. At the postpartum visit women in the intervention group who had quit smoking by the first prenatal visit had higher validated (cotinine < 200ng/ml) smoking cessation rates than those in the control group (N = 80, t = 2.449, p = .017). There was significant discordance between self-report of smoking status and urinary cotinine at all prevalence points, with no difference between groups. The average specificity for the total sample during the study period was 66.5%, showing that 33.5% of women who denied smoking had positive urinary cotinine assays. The results support the need for further research in several areas of system changes: how tobacco use is assessed and documented by providers, the re-evaluation of cessation programs, and using monitored validated cessation rates as outcome measures rather than solely self-report.

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