Do Clinicians Ask Pregnant Women about Exposures to Tobacco and Cannabis Smoking, Second-Hand-Smoke and E-Cigarettes? An Australian National Cross-Sectional Survey.

Gillian Gould,Christopher Oldmeadow,Billie Bonevski,Yael Zeev,Simon Chiu,Laura Tywman,Marilyn Clarke

doi:10.3390/ijerph14121585

Abstract

Clinicians often ask pregnant women about tobacco smoking, but their practices of asking about other smoking and nicotine exposures are unknown. This study analysed how often clinicians ask pregnant women about their use of e-cigarettes, cannabis, chewing tobacco, and second-hand smoke (SHS) exposure. Two cross-sectional surveys were undertaken. A random sample of 500 General Practitioner (GP) members were invited from the National Faculty of Aboriginal and Torres Strait Islander Health (NFATSIH) to complete an on-line survey, and 5571 GP and Obstetrician (OBS) members of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) were sent a paper survey by mail. Questions on frequency of asking about the exposures used Likert Scales, later dichotomized to “often-always” and “never-sometimes”. Logistic regressions estimated associations between clinician type and asking about cannabis, e-cigarettes, chewing tobacco, and SHS. An adjusted model reduced potential confounders of location, guidelines, gender and population. n = 378 GPs and OBS participated (6.2% response). In total, 13–14% asked “often-always” about e-cigarettes; 58% cannabis; 38% cannabis with tobacco; 27% SHS, and 10% chewing tobacco—compared to 95% of the sample asking about cigarette smoking. After adjustment, the odds of RANZCOG GPs (OR 0.34) and OBS (OR 0.63) asking about cannabis were lower compared to NFATSIH GPs. Clinician type was non-significant for asking about e-cigarettes, chewing tobacco and SHS. Surveyed Australian GPs and obstetricians asked less frequently about e-cigarettes, chewing, SHS exposure, and cannabis, potentially missing important exposures for mother and child.

Highlights

Exposures of the foetus to a range of toxic substances can adversely influence the life trajectory.Tobacco smoking has well-known major adverse effects on the developing foetus and the mother [1].For the foetus, these influences from tobacco may include growth restriction, pre-term birth, stillbirth, abnormal lung and neurological development, and birth defects
This sample was relevant as in Australia, Aboriginal and Torres Strait Islander women have a higher prevalence of tobacco smoking than the general population, and more likely to be exposed, for example, to second-hand smoke (SHS)
Participants came from all states and territories in Australia: Australian Capital Territory n = 2 (0.5%); New South Wales n = 100 (26.5%); Northern

Summary

Introduction

Exposures of the foetus to a range of toxic substances can adversely influence the life trajectory.Tobacco smoking has well-known major adverse effects on the developing foetus and the mother [1].For the foetus, these influences from tobacco may include growth restriction, pre-term birth, stillbirth, abnormal lung and neurological development, and birth defects. Exposures of the foetus to a range of toxic substances can adversely influence the life trajectory. Tobacco smoking has well-known major adverse effects on the developing foetus and the mother [1]. For the foetus, these influences from tobacco may include growth restriction, pre-term birth, stillbirth, abnormal lung and neurological development, and birth defects. If a mother smokes during pregnancy, her child is more likely to experience respiratory illnesses, childhood cancer, learning and behavioural problems, and chronic diseases such as obesity, respiratory, cardiac, and diabetes [1]. Res. Public Health 2017, 14, 1585; doi:10.3390/ijerph14121585 www.mdpi.com/journal/ijerph

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