Public Health Nursing Acceptance of the 5 A's Protocol for Prenatal Smoking Cessation
Oregon’s efforts in tobacco cessation have historically focused on the general population and have depended on quit line services as the primary intervention. The Oregon Smoke Free Mothers and Babies Program (SFMB) was developed in 2002 to focus on public health nurses and prenatal care providers who work with high risk pregnant women. It seeks to increase smoking cessation among low income and other high risk pregnant women by disseminating the U.S. Public Health Service best practices, the 5 A’s (Ask, Advise, Assess, Assist, Arrange) tobacco brief intervention protocol, to public health nurses and prenatal care providers. Interventions included teaching nurses the 5 A’s, how to use stages of change for pregnant quitters and providing them with client materials. We report the survey results gathered from nurses regarding their use of the 5 A’s. Nurses were questioned at 3 intervals: at the beginning of the SFMB project, 12 months later and 24 months later. While over 45 nurses in 10 counties were involved in the program, staff turnover and budget cuts affected program evaluation and analysis of the survey responses. As a result, only 10 nurses completed all three surveys. We found that, at baseline, all of the nurses were already performing the Ask and Advise components. The training resulted in a significant increase in the nurses using Assess (p<0.05) and Assist (p<0.05) both at 12 and 24 months. We also found that there was a statistically significant increase in the use of Arrange at 12 months (p<0.01) that was not sustained at 24 months (p=0.07). We conclude that public health nurses were already routinely doing Ask and Advise; our 5 A’s program was successful in improving Assess and Assist. More work is needed to understand why increases in Arrange were not sustained.