Smoking Cessation

How I Practice Video Series
Heather Z. Sankey, MD, CPE, FACOG

HIP: Smoking Cessation from ACOG on Vimeo.


Tobacco use is something I like to address at every single visit with my patients but clearly I don’t have time to go into deep history on every visit so I focus on two times. One is the GYN well-woman visit where I take a detailed smoking history. I find out how long she’s been smoking, what type of cigarettes, how many cigarettes a day, and sometimes it’s useful to find out who smokes at home around the house she’s partnered with. But the single most important question is to ask her whether or not she’s interested in cutting down or quitting. If the answer is no, then talking to her more, talking at her, isn’t going to make a difference. So at that point I let her know that I’m a good resource in case she does ever want to quit smoking. She can come back and talk to me and I’m happy to go over options for treatment and counseling. And then, that’s where we leave it. It’s sort of a friendly, supportive statement. If, on the other hand, she indicates that she is interested in quitting or cutting down, then we sit down to have a conversation about it. I think it’s very important to find out what she’s tried in the past. Many women have tried to quit in prior years and are feeling disheartened that they’ve gone back to smoking. So I reassure her that that’s actually very normal. It actually takes a number of tries to successfully become a nonsmoker or a former smoker. With that reassurance, we then move on to talk about what worked for her, what are her biggest challenges. Is it the actual nicotine and the withdrawal she faces or is it the habit, the regular “I always light up when I have a cup of coffee or when I drink? Is this the way I take a break from work?” There are really two different approaches. If nicotine withdrawal is a big issue, then we talk about nicotine replacement. There’s a number of different medications that can work. If, on the other hand, it’s the habit well then you really have to look at your environment and you have to look at tips and tidbits for replacing smoking with something. Many women are worried about gaining weight so you have to be cognizant of that. It’s a process that we go through over time. We’re lucky in Massachusetts to have a program called that partners with providers and patients so that when I sign her up for this program, she can get regular reminders, she can get smoking cessation counseling. And that takes the onus off of me for doing all of the follow up but she knows that I’m partnering with her to help her quit smoking. The other time that I think it’s very important to approach smoking cessation is in a new OB visit. Often pregnant women are very motivated to quit smoking so this is an excellent time and many of them succeed in quitting on their own being motivated by the pregnancy. But for those who want to quit but can’t, I will go ahead and prescribe nicotine replacement. It is much safer than the alternative of tobacco, which has thousands of other chemicals including carbon monoxide. So often if they go to a nicotine replacement they can wean down gradually and eventually decrease the exposure to the infant. But then in obstetrics I do tend to approach it several times during the pregnancy, particularly if she wasn’t interested in quitting at the beginning. Often as the pregnancy goes along she is more willing to quit, so I will partner with her at that time. But always to make sure that I’m not threatening her, I’m not challenging her, I’m really just encouraging her to consider it and then partner with her. And that’s how I practice.


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