Article Figures & Data
Figures
- Figure 1.
A, Physician perceptions of prevalence of traditional cigarettes, marijuana, e-cigarettes/ENDS, and synthetic marijuana for pregnant women. B, physician screening for traditional cigarettes, marijuana, e-cigarettes/ENDS, and synthetic marijuana among pregnant women. ENDS, Electronic-Nicotine Delivery..
Tables
- Table 1.
Sample Characteristics by Obstetric Care and Nonobstetric Care Provider Status (N = 1131)
Respondent Characteristic Obstetric Care PCPs, No. (%) Nonobstetric Care PCPs, No. (%) χ2 P N 417 (100) 714 (100) Female, n (%) 233 (56.0) 330 (46.6) 9.3 <.01 Age (years)* 49.0 <.0001 <40 129 (31.0) 140 (19.7) 40 to 49 153 (36.8) 195 (27.5) 50 to 59 87 (20.9) 208 (29.3) 60+ 47 (11.3) 167 (23.5) Race/ethnicity 11.2 .02 White, non-Hispanic 334 (80.3) 591 (83.6) Asian 21 (5.1) 50 (7.1) Black, non-Hispanic 17 (4.1) 26 (3.7) Hispanic 24 (5.8) 25 (3.5) Other 20 (4.8) 15 (2.1) Rank† 32.2 <.0001 Visiting professor or N/A 60 (5.4) 62 (5.6) Assistant professor 180 (44.0) 254 (35.9) Associate professor 118 (28.9) 216 (30.6) Full professor 51 (12.5) 175 (24.8) Terminal degree‡ 6.2 .01 MD 390 (94.0) 640 (89.6) DO or other 25 (6.0) 74 (10.4) Half days of seeing patients 4.2 .12 <3 190 (45.9) 361 (51.1) 3 to 6 205 (49.5) 306 (43.3) 7+ 19 (4.6) 40 (3.6) Primary role§ 55.3 <.0001 Clinical teaching 268 (64.9) 326 (46.2) Administration 75 (18.2) 226 (20.2) Clinical care 42 (10.2) 76 (10.8) Research 5 (1.2) 43 (6.1) Faculty development 9 (2.2) 5 (0.7) Non-academic physician/other 14 (3.4) 30 (4.3) Actively teach students/residents 414 (99.5) 696 (97.6) 5.8 .02 Provide adult inpatient care‖ 410 (98.3) 597 (84.3) 54.8 <.0001 Provide ICU/CCU care‖ 237 (57.1) 314 (44.8) 15.8 <.0001 Provide nursing home care‖ 326 (78.4) 524 (74.0) 2.7 .10 Provide newborn nursery care‖ 399 (95.9) 513 (72.9) 91.8 <.0001 Provide pediatric inpatient care‖ 307 (73.8) 398 (56.6) 33.1 <.0001 Provide surgical inpatient procedures‖ 126 (30.7) 84 (12.1) 58.2 <.0001 Provide emergency room care‖ 172 (41.8) 240 (34.4) 5.93 .01 Respondent Characteristic Obstetric Care PCPs, M (SD) Nonobstetric Care PCPs, M (SD) t(df) P Percent time: direct patient care 34.6 ± 18.0 32.0 ± 20.7 t(1116) = 2.15 .03 Percent time: research 6.3 ± 9.5 9.9 ± 14.9 t(924) = −4.1 <.0001 Percent time: administration 27.3 ± 17.6 33.0 ± 22.1 t(1081) = −4.4 <.0001 Percent time: teaching 33.0 ± 16.6 27.4 ± 17.8 t(1106) = 5.2 <.0001 Percent time: other 6.5 ± 10.6 8.8 ± 14.6 t(924) = −1.4 <.16 Years since residency graduation 15.2 ± 9.7 20.0 ± 10.9 t(1128) = −7.5 <.01 Where numbers do not add up to the total sample size, the remainder represent missing data.
↵* The categories, “<30” and “30 to 39” were combined to “<40” due to fewer than 5 respondents in the <30 age range.
↵† “Visiting professor” and “Not applicable (N/A)” were combined due to fewer than 5 respondents endorsing visiting professorships.
↵‡ Only 1 respondent chose “other”.
↵§ ”Non-academic physician” and “other” were combined due to fewer than 5 respondents endorsing “non-academic physician.”
↵‖ The stem for this question was, “Do you OR any of your family physician practice partners provide the following services?”
PCP, primary care physicians; SD, Standard Deviation.
- Table 2.
Provider-Estimated Prevalence of Traditional Cigarettes, Marijuana, Synthetic Marijuana, E-Cigarettes/ENDS, NRT, and Smoking Cessation Medications (N = 417)
Survey Question Response Options, No. (%) None (0%) Very Few (1% to 5%) Some (6% to 25%) Many (≥26%)* Don’t Know P Pregnant patients <18 years† 12 (3) 144 (36) 216 (54) 25 (6) 0 (0) <.0001 How many pregnant patients use‡ Traditional cigarettes 4 (1) 122 (31) 212 (54) 45 (12) 8 (2) <.0001 Marijuana 10 (3) 120 (31) 190 (49) 38 (10) 33 (8) <.0001 Synthetic marijuana§ 54 (14) 88 (23) 21 (5) 1 (0) 227 (58) <.0001 E-cigarettes (or other ENDS) 46 (12) 143 (37) 92 (24) 3 (1) 107 (27) <.0001 NRT‖ 70 (18) 174 (45) 80 (20) 1 (0) 66 (17) <.0001 Medications for smoking cessation¶ 141 (36) 145 (37) 38 (10) 1 (0) 65 (17) <.0001 Where numbers do not add up to 417, the remainder represent missing data.
↵* The response categories of “Many (26% to 50%)” and “Most (>50%)” were collapsed due to low endorsement (n < 5) of the “Most (>50%)” category for all survey items.
↵† “How many of your pregnant patients are <18 years of age?”
↵‡ The full stem was, “In your practice, please estimate how many pregnant patients use the following:”
↵§ The full stem was, “Synthetic marijuana (e.g., K2, Spice).”
↵‖ The full stem was, “Nicotine replacement therapy (e.g., patches, gum, lozenges, nasal spray, or inhaler).”
↵¶ The full stem was, “Medication for smoking cessation (Bupropion [Zyban] or Varenicline[Chantix]).”
ENDS, electronic nicotine delivery systems; NRT, nicotine-replacement therapy.
- Table 3.
Provider Perceptions of Safety for Pregnant Patients to Use Traditional Cigarettes, Marijuana, Synthetic Marijuana, E-Cigarettes/ENDS, NRT, or Breastfeed While Smoking (N = 417)
Survey Question* No. (%) Safe† Unsafe† Smoke cigarettes 3 (1) 386 (99) Be exposed to SHS regularly 13 (3) 376 (97) Smoke/use marijuana 30 (8) 359 (92) Smoke/use synthetic marijuana 3 (1) 384 (99) Use e-cigarettes/ENDS 35 (9) 352 (91) Use NRT 218 (56) 171 (44) Breastfeed while smoking 103 (27) 283 (73) Where numbers do not add up to 417, the remainder represent missing data.
↵* The question stem was, “In your personal opinion, how safe is it for pregnant patients (during ANY trimester) to:”.
↵† Response options included, “Very Safe, Safe, Somewhat Safe, Unsafe, or Very Unsafe.” Very safe, safe, and somewhat safe were collapsed to “Safe,” and unsafe and very unsafe were collapsed to “Unsafe,” for parsimony and due to low endorsement for some categories.
ENDS, electronic nicotine delivery systems; NRT, nicotine-replacement therapy (eg, patches, gum, lozenges, nasal spray, or inhaler); SHS, secondhand smoke.
- Table 4.
Provider-Reported Screening for Traditional Cigarettes, SHS Exposure, Marijuana, Synthetic Marijuana, and E-Cigarette/ENDS (N = 417)
Survey Question No. (%) Less-Consistent Screening Consistent Screening Never or Rarely* Sometimes Often Very Often Always How often screen pregnant patients for:† Use of traditional cigarettes 3 (1) 5 (1) 24 (6) 27 (7) 328 (85) Presence of a smoker in home‡ 10 (3) 31 (8) 54 (14) 107 (28) 184 (48) Use of marijuana 5 (1) 38 (10) 45 (12) 56 (15) 241 (63) Use of synthetic marijuana 133 (37) 63 (16) 38 (10) 34 (9) 108 (28) Use of e-cigarettes/ENDS 81 (21) 68 (18) 52 (13) 59 (15) 127 (33) Where numbers do not add up to 417, the remainder represent missing data.
↵* “Never” and “rarely” were collapsed due to low response endorsement (n<5) for several survey items, including cigarettes, presence of a smoker, and marijuana.
↵† The full stem was, “In your practice, how often do you screen your pregnant patients (via ANY method: interview, patient-completed form, or laboratory testing) for the following:”
↵‡ The full stem was, “Presence of a smoker (other than the pregnant patient) in the home.”
ENDS, electronic nicotine delivery system; SHS, secondhand smoke.
- Appendix.
Selected CERA 2016 General Membership Survey Items with Embedded Survey Instructions
Question Response Options 1) Do you currently provide labor and delivery maternity care within the United States? Yes No 2) How many of your pregnant patients are <18 years of age? None (0%) Very few (1% to 5%) Some (6% to 25%) Many (26% to 50%) Most (>50%) Instructions: The following questions relate to the prevalence of tobacco products (including electronic-cigarette [e-cigs] and other electronic-nicotine devices [ENDS]) and marijuana (including synthetic marijuana use) during pregnancy. An e-cigarette is a device that emits doses of vaporized nicotine to be inhaled. Synthetic marijuana refers to “Spice” or “K2,” or any other substance sold over-the-counter (often in gas stations) and commonly marketed or perceived as a synthetic cannabinoid. 3) In your practice, please estimate how many pregnant patients use the following: a) Traditional cigarettes Don’t know None (0%) Very few (1% to 5%) Some (6% to 25%) Many (26% to 50%) Most (>50%) b) E-cigarettes (or other ENDS) Same as 3a response scale (above) c) Nicotine replacement therapy (eg, patches, gum, lozenges, nasal spray, or inhaler) Same as 3a response scale (above) d) Medication for smoking cessation (Bupropion [Zyban] or Varenicline [Chantix]) Same as 3a response scale (above) e) Marijuana Same as 3a response scale (above) f) Synthetic marijuana (e.g., K2, Spice) Same as 3a response scale (above) 4) In your personal opinion, how safe is it for pregnant patients (during ANY trimester) to: a) Smoke cigarettes Very safe Safe Somewhat safe Unsafe Very unsafe b) Be exposed to secondhand smoke regularly Same as 4a response scale (above) c) Use e-cigarettes (or other ENDS) Same as 4a response scale (above) d) Use nicotine replacement therapy (e.g., patches, gum, lozenges, Nasal spray, or inhaler) Same as 4a response scale (above) e) Smoke or use marijuana Same as 4a response scale (above) f) Smoke or use synthetic marijuana (e.g., K2, Spice) Same as 4a response scale (above) g) Breastfeed while smoking (after delivery) Same as 4a response scale (above) 5) In your practice, how often do you screen your pregnant patients (via ANY method: interview, patient completed form, or laboratory testing) for the following: a) Use of traditional cigarettes Never Rarely Sometimes Often Very often Always b) Presence of a smoker (other than the pregnant patient) in the home Same as 5a response scale (above) c) Use of e-cigarettes (or other ENDS) Same as 5a response scale (above) d) Use of marijuana Same as 5a response scale (above) e) Use of synthetic marijuana (eg, K2, Spice) Same as 5a response scale (above) 6) If your practice screens pregnant patients for tobacco products (including electronic-nicotine devices [ENDS]) or marijuana (including synthetic marijuana) using any method, please select ALL methods you use. “Patient report” refers to a patient-completed form or a patient interview. a) Patient report about tobacco/nicotine use b) Patient report about marijuana use c) Laboratory test for screening for tobacco/nicotine use d) Laboratory test for screening for marijuana use 7) What have you prescribed or recommended to your pregnant patients who want to quit smoking? (choose all that apply) a) Nicotine replacement therapy (i.e., gum, lozenges, patches, inhaler, nasal spray) b) E-cigarettes c) Bupropion (Zyban) d) Varenicline (Chantix) e) Not applicable, I have not prescribed or recommended ANY of these 8) For the overall population, do you believe people who use e-cigarettes have a lower risk of cancer compared to traditional cigarettes? Yes About the same No 9) How often does each of the following patient groups ask you about the safety of e-cigarette use or their efficacy as a smoking cessation aid? a) Pregnant patients Frequently Sometimes Rarely Never b) All other patients Same as 9a response scale (above) 10) If recreational marijuana use (i.e., not prescribed) becomes legal (or already is) in my state, I would advise my patients NOT to use it: a) Pregnant patients True False b) All other patients True False
