Evaluation of a nurse and midwife delivered 5As prenatal smoking cessation program in rural communities

Background: Women in rural Appalachia face health disparities, challenges of access to care, and poor maternal-infant health outcomes. West Virginia (WV) has the highest prenatal smoking prevalence rates in the nation. The ACOG 5As evidence-based prenatal smoking cessation intervention has limited documented evaluation of effectiveness in rural communities. The purpose of the study was to evaluate the implementation of the ACOG 5As intervention delivered by trained midwives working with a team of nurse researchers. Method: Prospective evaluation of the implementation of the 5As intervention for 35 women in four WV counties who smoked during pregnancy. Surveys were conducted by the study team and women self-reported smoking behaviors at baseline, one month post-intervention, two months post-intervention, and postpartum. Results: Post-intervention smoking rates and levels decreased compared to baseline: 91% decreased smoking and 9% quit by one month. Using repeated measures ANOVA, there was a reduction in the average number of cigarettes, from approximately 10 cigarettes at baseline to 8 at one month, 7 at two months, and 6 by delivery (p=0.002). The women further reduced their tobacco exposure by increasing indoor smoking restrictions (p=0.001). The rate of initiation of the first cigarette within half an hour of waking declined from 46% to 29%. Conclusions: The incorporation of the 5As intervention into prenatal care delivered by midwives and nurse researchers promotes a decrease in prenatal smoking rates and frequency. Guiding women in techniques and strategies aimed at reducing cigarette smoking facilitates decreased maternal and fetal smoking exposure.