Nurse and Midwife Delivered Prenatal Smoking Cessation Intervention in Rural Appalachia

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. Limited evaluation of evidence-based smoking cessation interventions conducted by nurses working with women in rural Appalachia has been published. The purpose of the study was to evaluate the delivery of the ACOG 5As intervention by a trained team of midwives and nurse researchers.

Method: Prospective evaluation of the implementation of the 5As intervention for 35 women in four rural WV counties who smoked during pregnancy. Midwives initiated 5As during prenatal care and nurse researchers called monthly to provide encouragement, advice, and cessation strategies. Surveys included self-reported smoking behaviors at baseline, one month post-intervention, two months post-intervention, and postpartum.

Results: Post-intervention smoking rates and levels improved compared to baseline: 91% decreased and 9% quit smoking. Using repeated measures ANOVA, average number of cigarettes decreased from 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 enforcing indoor smoking restrictions. The percent of women with indoor smoking restrictions increased from 46% at baseline, to 55% at one month, 57% at two months, and 93% by delivery (p=0.001).

Conclusions: The incorporation of the evidence-based 5As intervention into prenatal care delivered by midwives and nurses to women living in rural WV facilitated decreased prenatal smoking rates and frequency thereby decreasing maternal and fetal smoking exposure.