BACKGROUND: Pediatric well-care visits provide a clinical opportunity to counsel new mothers about their smoking and the deleterious effects of environmental tobacco smoke (ETS) on infant health. METHODS: Forty-nine Oregon pediatric offices enrolled 2,901 women who were currently smoking or had quit for pregnancy, using a brief survey at the newborn's first office visit. Randomly assigned offices provided advice and materials to mothers at each well-care visit during the first 6 months postpartum to promote quitting or relapse prevention. RESULTS: The intervention reduced smoking (5.9% vs 2.7%) and relapse (55% vs 45%) at 6-month follow-up, but logistic regression analysis at 12 months revealed no significant treatment effect. The intervention had a positive effect on secondary outcome variables, such as readiness to quit and attitude toward and knowledge of ETS. Multiple logistic regression analysis indicated that husband/partner smoking was the strongest predictor of maternal quitting or relapse. CONCLUSIONS: A pediatric office-based intervention can significantly affect smoking and relapse prevention for mothers of newborns, but the effect decreases with time. Consistent prompting of the provider to give brief advice and materials at well-care visits could provide a low-cost intervention to reduce infant ETS exposure.

Cost-Benefit Analysis↗

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Behavioral research contributions and needs in cancer prevention and control: tobacco use prevention and cessation.

Following a brief review of the etiology and prevalence of tobacco use and data on the effectiveness of prevention and cessation interventions, recommendations for a research agenda are outlined. It is suggested that research on youth tobacco initiation and cessation be given highest priority because of rising prevalence rates, fundamental social importance, and the widespread support for such efforts. Policy and community approaches to deterring youth tobacco use deserve particular attention. Adult intervention research should focus on health care settings and include factors that both help and hinder adoption and routine implementation of tobacco interventions by clinicians. Developing and evaluating practical ways of using nicotine replacement therapies or other pharmacological therapies in primary care are also of importance. Media interventions that segment the smoking population by age, ethnicity, and developmental milestones should be encouraged. Three approaches could profit from working conferences of investigators and other interested parties to review the data and suggest research directions: worksite interventions, interventions with ethnic populations, and matching or tailoring interventions to specified characteristics of smokers. The importance of devoting considerable resources to investigator-initiated contrasted with sponsor-directed research is discussed.

Adolescent↗