Tobacco-Related Healthcare Among Women of Reproductive Age [29J

Abstract

INTRODUCTION: After a decades-long decline, smoking prevalence has plateaued. It remains one of the most important modifiable risk factors for dozens of health and birth outcomes. Despite evidence that advice to quit and brief counseling improve quit rates, tobacco-related healthcare is suboptimal. We examined correlates of the receipt of tobacco-related healthcare in ambulatory care visits by women of reproductive age. METHODS: The National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) collect data annually from nationally-representative samples of ambulatory care visits. We analyzed restricted data on 130,363 visits by women aged 15-44 in the NAMCS and NHAMCS surveys for the years 2001-9. RESULTS: Tobacco use was identified in 67% of women and 73% of pregnant women, and this frequency decreased from 2001 to 2009 among pregnant women. Tobacco use/exposure counseling was provided in 19% of visits by tobacco users and 21% of visits by pregnant tobacco users. Obstetrician-gynecologists were more likely to identify tobacco use than were most other specialists. Pregnant women were more likely to have tobacco use identified than were nonpregnant women. Non-white patient race was associated with a lower rate of tobacco use identification. Medical school-affiliated outpatient departments were less likely to identify tobacco use but more likely to provide tobacco use/exposure counseling. CONCLUSION: Low and declining rates of identification of tobacco use reinforce the need for improvement. Several associations with suboptimal tobacco-related healthcare were identified which can help tailor programs for improvement.