March/April - West Virginia State Medical Association

Scientific Article |
Encouraging Smoking Cessation during Pregnancy in
West Virginia: Using Fax-to-Quit as a Cessation Strategy
Cindy Tworek,PhD, MPH
Department of Pharmaceutical Systems and Policy,
WVU School of Pharmacy, Morgantown
Translational Tobacco Reduction Research Program,
Mary Babb Randolph Cancer Center, Morgantown
Kimberly A. Horn, EdD
Translational Tobacco Reduction Research Program,
Mary Babb Randolph Cancer Center, Morgantown
Department of Community Medicine, WVU School of
Medicine, Morgantown
Robert H. Anderson, MA, CHES
Translational Tobacco Reduction Research Program,
Mary Babb Randolph Cancer Center, Morgantown
Department of Community Medicine, WVU School of
Medicine, Morgantown
Ilana Chertok, PhD
WVU School of Nursing, Morgantown
Robin L. Danek, MPH
WVU Research Corporation, Morgantown, WV
Alan Holmes, MBA
beBetter Health, Inc., Charleston
Bruce Adkins, MS, PA
Division of Tobacco Prevention, West Virginia Bureau
for Public Health, Charleston
Corresponding Author: Cindy Tworek, PhD, MPH, WVU
School of Pharmacy/MBR Cancer Center, Morgantown,
WV 26506 ctworek@hsc.wvu.edu
Abstract
Despite known dangers of smoking, a
majority of pregnant women continue to
smoke or relapse following delivery. West
Virginia women have high unmet needs
for smoking cessation, and the prenatal
period presents a critical and unique
opportunity for education and quitting
assistance. West Virginia’s Fax-to-Quit
program uses provider-faxed referrals to
the Quitline to engage smokers and
connect them with cessation services. A
12-month feasibility evaluation of this Faxto-Quit
program for pregnant women was
conducted. In February 2009, providers
and staff from three OB/GYN clinics in
three adjoining West Virginia counties
were recruited. All participating sites
received an intensive half-day training
program. Adult pregnant smokers
receiving prenatal care in these OB/GYN
clinic sites were eligible to participate.
Recruitment sites screened pregnant
women for smoking; assessed readinessto-quit;
and enrolled consenting
participants in the Fax-to-Quit Program.
The Quitline measured cessation
attempts with six-month follow-up of
enrolled participants. Between March-
December 2009, 58 referrals were made
at these OB/GYN clinic sites, with 15
women (25.9%) enrolling in Quitline
services. These enrolled women account
for approximately one-quarter of calls
from pregnant smokers to the West
Virginia Quitline in the past 12 months.
Contact, communication, and cooperation
with office staff were relevant and
important to successful project
implementation. Findings indicate that
Fax-to-Quit is feasible to engage
providers and pregnant smokers with the
West Virginia Quitline. Successful
referrals and enrollment demonstrate Faxto-Quit
may support cessation by
increasing Quitline use and connecting
pregnant women who smoke with quitting
services through provider-faxed referrals
to the West Virginia Quitline.
Introduction
Despite known dangers of
smoking during pregnancy, only
18-25% of pregnant women quit,
and a majority return to smoking
following delivery. 1-2 West Virginia
(WV) women have high unmet needs
for smoking cessation, and 2009
WV smoking prevalence among all
adults (25.6%) is tied with Kentucky
for the highest rate among US
states. 3 Pregnancy Risk Assessment
Monitoring System (PRAMS) data
from 2000-2005, showed increasing
WV smoking rates before, during,
and after pregnancy, in contrast with
declining US rate. 4 WV 2005 PRAMS
data reported 45.8% of women
smoked 3-months prior to pregnancy,
while 31.9% smoked during
pregnancy, with a US rate of 11.7%. 5
Approximately 36% of WV’s 18-24
year-old pregnant women smoke,
and prevalence in some remote
rural counties approaches 50%. 6,7
Health risks of smoking before,
during, and after pregnancy are
well-established, including increased
risks of premature birth, low birth
weight, and infant death. Infants
born to a smoking mother weigh on
average 200 grams less, and pregnant
women exposed to secondhand
smoke have a 20% greater likelihood
of a low birth weight baby. 1,5 The
prenatal period presents a critical
and unique opportunity for smoking
cessation education and assistance.
Quitline use has been shown to
increase successful cessation, and
likewise, telephone counseling has
also demonstrated effectiveness
as a cessation method offered to
pregnant smokers. 8-9 The West
Virginia Tobacco Quitline is a free
service available to residents, and
among 4,367 adults enrolled in
2008, 3.0% were pregnant women. 10
Fax-to-quit programs have been
used successfully to enhance
provider-delivered smoking
cessation counseling in communitybased
practices. 11 WV’s Fax-to-Quit
program involves a providerfaxed
referral to the Quitline,
engaging smokers and connecting
them with cessation services. A
12-month feasibility evaluation
of WV’s Fax-to-Quit program for
pregnant women was conducted
to: establish a collaborative of
stakeholders; develop a Fax-to-Quit
protocol; pilot the program among
WV pregnant smokers; assess
feasibility and impact to guide
future cessation interventions.
Methods
In February 2009, providers and
staff from three OB/GYN clinics in
three adjoining counties of North
16 West Virginia Medical Journal