Perceptions and Use of Smoking Cessation in Nurse-Midwives' Practice


  • James H. Price MPH, PhD,

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    • James H. Price, MPH, PhD, is Professor and Director of the Division of Public Health in the Department of Public Health and Rehabilitative Services, University of Toledo.

  • Timothy R. Jordan PhD, Med,

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    • Timothy R. Jordan, PhD, is an assistant professor whose interests include tobacco prevention and control, health behaviors, adolescent health, gerontology, and health communication.

  • Joseph A. Dake MPH, PhD

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    • Joseph A. Dake, MPH, PhD, is an assistant professor at Wayne State University and teaches courses in program evaluation, statistics and data analysis, and health behavior.

Department of Public Health, University of Toledo, Toledo, OH 43606. E-mail:


The objective of this study was to examine Ohio nurse-midwives' perceptions and use of a smoking cessation protocol in assisting pregnant smokers. The total population of licensed Ohio nurse-midwives (n = 300) was surveyed by using a cross-sectional survey design. Only 4 of 10 items that assessed a nationally recommended method of promoting smoking cessation were done by 50% or more of respondents. Few nurse-midwives identified barriers to counseling pregnant patients who smoked, but the most common were lack of time (14%) and not knowing where to send pregnant smokers for treatment (14%). Most respondents believed that nicotine replacement therapy (NRT) would be most likely to reduce the number of pregnant smokers (74%), yet few (26%) were confident in their ability to prescribe/recommend nicotine replacement therapy. Respondents more likely to use 5 A's can be characterized as the following: had higher efficacy expectations in their ability to communicate issues about the 5 A's and had higher outcome expectations regarding the effects of using the 5 A's. Nurse-midwife training programs and continuing education needs to include current research in nicotine replacement therapy use in pregnant patients and 5 A's techniques to assist pregnant smokers in quitting.