Smoking cessation.(WOMEN'S HEALTH ADVISER)

About 21% of American women, or more than 20 million, smoke cigarettes, with prevalence being the highest, about 32%, among Native American women.

According to the Office of the Surgeon General, smoking is probably the most important preventable cause of poor pregnancy outcomes among women in the United States. It's associated with an increased risk of miscarriage, stillbirth, preterm delivery, and infant death, and is a cause of low birth weight in infants. According to the American College of Obstetricians and Gynecologists, about 10% of all infant deaths could be prevented if pregnant women did not smoke.

And ob.gyns. are in a unique and powerful position to help change those numbers, experts say. Women are especially open to lifestyle change during preconception counseling and pregnancy. Yet one study indicated that ob.gyns. do not always take advantage of them. While 93% of 130 ob.gyns. surveyed said they always ask about smoking and advise quitting, only 25% offer to help patients quit or follow up. (South. Med. J. 2001:94;297-303).

Because of nicotine's powerfully addicting properties, many smokers are not ready to quit when first approached. Many are not able to quit on their own, and most who ultimately quit are not successful on the first try. That is why it is important to address smoking at every visit. Cessation rates improve when doctors take just 15 minutes to use the "Five A's" strategy:

* Ask. Document tobacco use at every visit. Try to avoid a yes or no question such as "Do you smoke?" Instead, offer multiple-choice questions that elicit more specific information.

* Advise. Recommendations to quit should be clear, strong, and personal. You can tailor it to the patient's situation: Young women may respond better to messages about immediate improvements, such as "Your hair and breath will smell better" and "You'll save money." It also can be helpful to explain related health benefits. Women who are pregnant or considering pregnancy should get clear information about the risks of poor pregnancy outcomes.

* Assess. What is the patient's willingness to quit? If she is not willing to make an attempt now, explore some of the rewards she would reap, such as saving money, improving her health and that of her family, and setting a good example for her children. Help the patient identify issues that can make ...