Best practices for smoking cessation in pregnancy: do obstetrician/gynecologists use them in practice?

J Womens Health (Larchmt). 2006 May;15(4):400-41. doi: 10.1089/jwh.2006.15.400.


Objective: To assess Ohio obstetrician/gynecologists' perceptions and use of the 5As method of smoking cessation (ask, advise, assess, assist, and arrange) with pregnant patients who smoke.

Methods: A three-wave mailing procedure was used with a statewide random sample of obstetrician/ gynecologists who responded to a valid and reliable 31-item questionnaire.

Results: Regarding the 5As method of smoking cessation, almost all (98%) asked their pregnant patients about smoking, but fewer respondents engaged in advising (66%), assessing (42%), assisting (29%), and arranging for follow-up visits or referrals (6%). Higher efficacy expectations were associated with greater use of the 5As method (r = 0.52, p < 0.001). A majority believed that two cessation activities would result in smoking cessation in pregnant smokers: explaining the dangers of smoking (65%) and referring pregnant smokers to smoking cessation programs (57%). However, 26% of physicians reported that they were "slightly confident" or "not confident at all" in their ability to refer pregnant smokers to such programs, and 6% of physicians reported always providing smoking cessation referrals. A significant proportion of respondents believed that prenatal smoking would not cause severe effects for the unborn child but would likely lead to moderate (46%) or minor (3%) health effects.

Conclusion: Obstetrician/gynecologists face many competing demands for their time and energy, yet 62% believed smoking cessation advice would be of significant value. Physicians with higher levels of efficacy expectations reported significantly greater use of the 5 As. Future research should explore ways to facilitate obstetrician/gynecologists' use of the 5As method.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Benchmarking / statistics & numerical data*
  • Clinical Competence
  • Continuity of Patient Care / statistics & numerical data
  • Counseling / methods
  • Female
  • Humans
  • Male
  • Ohio
  • Physician-Patient Relations
  • Population Surveillance
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pregnancy
  • Pregnancy Complications / prevention & control*
  • Smoking Cessation / methods*
  • Smoking Prevention*
  • Surveys and Questionnaires