Volume 198 - Issue 1
An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial
Authors: Gillian S Gould and Andy McEwen
Med J Aust 2013; 198 (1): 23. || doi: 10.5694/mja12.11221
Published online: 21 January 2013
Published online: 21 January 2013
To the Editor: We comment on practical aspects of the approach to maternal Indigenous smoking raised in the study by Eades and colleagues.1
Pregnant smokers face barriers to quitting; however, we believe some additional barriers are systemic,2 including excessive caution in prescribing nicotine replacement therapy (NRT). Guidelines for maternal smoking cessation recommend an unassisted attempt before considering NRT.3 There is no agreed definition of a “failed ...
To the Editor: We comment on practical aspects of the approach to maternal Indigenous smoking raised in the study by Eades and colleagues.1
Pregnant smokers face barriers to quitting; however, we believe some additional barriers are systemic,2 including excessive caution in prescribing nicotine replacement therapy (NRT). Guidelines for maternal smoking cessation recommend an unassisted attempt before considering NRT.3 There is no agreed definition of a “failed quit attempt”, or for how long a pregnant woman should persist unaided before NRT is tried. In this study, two failed attempts were a prerequisite. In a practice setting, this may be overcautious; intermittent NRT is considered less hazardous than continued smoking in pregnancy.4 If a pregnant woman is unable to abstain for 2–3 days, an accelerated option of intermittent NRT should be considered, to keep up momentum with the quit attempt. The attendance rate dropped from 64% at 3–5 days to 35% at 7–10 days — perhaps lost opportunities for initiating pharmacotherapy. The article does not detail the type of NRT (oral or transdermal), dosage, duration of treatment, compliance rates, or the management of side effects. These aspects would be of interest to smoking cessation practitioners.
Although this trial was unsuccessful, it should not discourage health professionals from delivering intensive interventions to pregnant Indigenous smokers. NRT is most effective when prescribed by a cessation specialist or medical practitioner, rather than bought over the counter.5 Additionally, behavioural support should ideally be for 4–7 sessions.6 Until a trial includes this level of support, intensive approaches should not be discounted.
Competing interests
Andy McEwen has received travel funding, honoraria and consultancy payments from manufacturers of smoking cessation products (Pfizer, Novartis UK and GlaxoSmithKline Consumer Healthcare). He also receives payment for providing training to smoking cessation specialists, receives royalties from books on smoking cessation, and has a share in a patent for a nicotine-delivery device.
Acknowledgements
Gillian Gould receives a National Health and Medical Research Council training scholarship for Indigenous health research, cofunded by the National Heart Foundation, and has received grants from the Australian Government Department of Health and Ageing to develop Indigenous smoking cessation programs.
References
- Eades SJ, Sanson-Fisher RW, Wenitong M, et al. An intensive smoking intervention for pregnant Aboriginal and Torres Strait Islander women: a randomised controlled trial. Med J Aust 2012; 197: 42-46. 0_CHDBCCFD
- Gould G, McEwen A, Munn J. Jumping the hurdles for smoking cessation in Indigenous pregnant women in Australia. J Smoking Cessation 2011; 6: 33-36. 0_pgfId-2696931
- Zwar N, Richmond R, Borland R, et al. Supporting smoking cessation: a guide for health professionals. Melbourne: Royal Australian College of General Practitioners, 2011. 0_pgfId-2696939
- Bittoun R, Femia G. Smoking cessation in pregnancy. Obstet Med 2010; 3: 90-93. 0_i1142877
- West R, Owen L. Estimates of 52-week continuous abstinence rates following selected smoking cessation interventions in England. Version 2. 9 Mar 2012. Smoking in England. http://www.smokinginengland.info (accessed Aug 2012).
- Fiore MC, Bailey WC, Cohen SJ, et al. Smoking cessation. Clinical Practice Guideline No. 18. Rockville, MD: US Department of Human and Health Services, Public Health Service, Agency for Health Care Policy and Research, 1996. 0_i1142881
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