Nicotine replacement prescription practices of obstetric and pediatric clinicians

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Abstract
Objective: To assess smoking cessation counseling and nicotine replacement therapy prescription and recommendation practices among obstetric and pediatric providers. Methods: We sent out a self-administered survey to 61 obstetric and pediatric nurse practitioners and physicians at six community health centers in the Boston area. Results: Obstetric providers were more likely to view smoking cessation counseling as their responsibility in treating pregnant women than pediatric providers did in treating infants with mothers who smoked (mean ± standard deviation [95% confidence interval] 4.5 ± 0.76 [4.2, 4.8] versus 4.0 ± 0.8 [3.7, 4.3] on a five-point scale; P < .05). Obstetric providers believed that smoking cessation counseling was more effective than did pediatric providers (3.45 ± 1.1 [3.0, 3.9] versus 2.8 ± 0.8 [2.5, 3.1] on a five-point scale; P < .05) and were more likely to report provision of cessation assistance than pediatric providers (63% [44%, 82%] versus 17% [5%, 29%]; P < .05). Obstetric providers were more likely to prescribe or recommend over-the-counter nicotine replacement therapy than pediatric providers (44% [25%, 63%] versus 11% [1%, 21%], P = .004). Reasons for not prescribing nicotine replacement differed according to specialty; however, perceived lack of efficacy was not a typical reason given by clinicians in either specialty. Only two of 47 practitioners who did not prescribe or recommend those therapies listed that as a factor in their decisions. Conclusion: We found that nicotine replacement therapies are commonly prescribed or recommended to pregnant smokers by obstetric providers, but less commonly to lactating women by pediatric providers.

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