1. Smoking and Pregnancy: Status Profile 2007 Annie Berthiaume Roberta Heale Irene Koren Rachelle Arbour-Gagnon Funded by the Louise Picard Research Grant

2. Background  Smoking during pregnancy has many known harmful effects  Women who smoke during pregnancy are faced with many complex issues relating to quitting.

3. Background Goals of a snapshot of smoking behaviours in pregnancy in the Sudbury Ontario area:  data about quit attempts,  barriers and supports to cutting down or quitting  role of the health care providers

4. This will help in planning programming to provide support to pregnant women who smoke.

5. Design and Sample Data was collected through a telephone survey. Sampling frame:  1820 live births in the Sudbury area in 2005  target was 317  Total consenting is 270 with 9 refusals  Survey completion March to September 2007

6. Objectives To describe smoking and cessation patterns among women prior, during, and after pregnancy. To Explore access to cessation services and perception of readiness to quit smoking or to remain smoke-free. To collect Socio-demographic information To assess potential risk factors for smoking during pregnancy

7. Eligibility and Recruitment Inclusion criteria:  Mothers who consented to 48 hour postpartum telephone assessment from Sudbury & District Health Unit RN.  Resident in the City of Greater Sudbury.  The sample included both smoking and non-smoking mothers

8. Questionnaire A skip pattern questionnaire to  identify those with smoking behaviour  reviewed smoking patterns, quit attempts, health care provider assistance and family support  Demographic data was collected on both smokers and non-smokers

9. Outcomes Tobacco use over study period (n=193) Smokers*(%) Before knowing about pregnancy5528.5 During first three months of pregnancy5025.9 During last six months of pregnancy4623.8 1-2 months postpartum5025.9

10. Age of Mothers Range 17- 41 years Mode = 28 years

11. SampleSmokers Level of education #Number(%) High school or less 493257.1 Post secondary * 1442442.9 Total19356100

12. Reported household income Total Sample # of Smokers (%) < $60,000662760 $60,000 +981840 Total16445100

13. Participant view on quitting smoking (n=56) Min.Max.ModeMedian Importance of quitting 110 8.0 Confidence to quit 11025.5 Commitment to quit 11085.0

14. Health Care Providers Health Care ProviderSampleAsked about smoking % Obstetrician14612887.6 Midwife332884.8 HBHC604168.3 Family Physician1379367.9 Nurse Practitioner17952.9

15. Health Care Provider SampleAdvised to quit smoking %Assist with pamphlets %Arrange community referral % Obstetrician Midwife* 533566.01834.0611.3 Other**572849.11119.34 7.0

16. Health Care Provider * Smokers (n=55) Non-smokers (n=137) Number(%)Number(%) Obstetrician4073.210776.6 Midwife1323.22014.6 HBHC Nurse1833.94329.9 Family Physician3258.910675.9 Nurse Practitioner712.5117.3

17. Discussion Of the women who reported smoking, 82.1% were under the age of 30. In this sample, more smokers reported a lower household income than non-smokers

18. Discussion Most women (54%) made at least one quit attempt during their pregnancy with “cold turkey” identified as the most common strategy.

19. Discussion Of the total number of women who smoked before they found out they were pregnant, 17.9 % quit smoking during their pregnancy which is lower than anticipated.

20. Discussion The number of women who quit smoking during pregnancy increased over the course of the pregnancy period with rates rising in the post partum period.

21. Discussion Women in this sample were more likely to smoke throughout their pregnancy if they reported being daily smokers.

22. Discussion Of the Five “A” Strategy of Ask, Advise, Assess, Assist, Arrange the most common intervention by the health care providers of this sample was Ask followed by a sharp drop for the remaining interventions.

23. Next Steps