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Am Fam Physician. 2003;68(8):1658-1660

Despite recent declines in overall smoking rates, smoking-related disease and mortality among women are increasing, especially among women who are socioeconomically disadvantaged. Women typically begin and continue smoking during their childbearing years, and this has a substantial effect on the health of their children. Studies have shown that many low-income women understand the negative consequences of their smoking for themselves and their children, and are interested in quitting. Physicians who are caring for young patients have the opportunity during the visit to assist a child's parents in smoking cessation. A recent study found that significant numbers of pediatricians discuss with the parents of their patients the health issues related to secondhand smoke for the children and offer advice on how to stop smoking. Unfortunately, the survey also found that rates of providing any additional support for smoking cessation were low. Curry and associates evaluated a smoking cessation intervention for women who presented with their children to a pediatric clinic serving low-income families.

The trial was a two-arm randomized study of self-identified women smokers whose children received care at pediatric clinics that served an ethnically diverse population of low-income families in the Seattle area. Subjects were randomized to receive smoking cessation intervention or usual care. All women completed a self-administered baseline survey. Women in the intervention group received a motivational message for smoking cessation from the child's physician during their scheduled clinic visit, a guide to smoking cessation, and a 10-minute motivational interview with a clinic nurse or study interventionist. Subjects also received as many as three telephone counseling calls from the nurse or the study interventionist during the three-month follow-up period. All participants received follow-up at three and 12 months after the initial visit, when data were obtained concerning their current smoking habits. The main outcome measure was self-reported abstinence from smoking 12 months after the start of the study. Abstinence was defined as not smoking, even a puff, during the seven days before the assessment.

A total of 303 women participated in the study. At enrollment, the distribution with regard to readiness to quit was as follows: 23 percent were in the precontemplation stage (not seriously considering quitting smoking within the next six months); 43 percent were in the contemplation stage (seriously considering quitting within the next six months); and 34 percent were in the preparation stage (planning to quit smoking within the next 30 days). Follow-up participation was similar in both groups, at approximately 80 percent. At three months, the abstinence rates were 7.7 percent in the intervention group and 3.4 percent in the usual-care group. At 12 months, the abstinence rates were 13.5 percent in the intervention group and 6.9 percent in the usual-care group. The difference in abstinence rates at the 12-month follow-up was statistically significant.

The authors conclude that there are longterm benefits from pediatric-based smoking cessation interventions, even in the population of hard-to-reach smokers. Based on these results, the authors argue that clinical guidelines for smoking cessation should be considered by those providing health care for children. The authors add that there is the potential for a substantial public health benefit if intervention strategies are implemented in this population of women and their children.

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