Physicians' missed opportunities to address tobacco use during prenatal care.

Smoking cessation during pregnancy reduces the risk of adverse perinatal outcomes and leads to long-term cessation for at least some women smokers. Prenatal care offers repeated opportunities for smoking status identification and smoking cessation counseling. Using cross-sectional data from the 1991-1996 National Ambulatory Medical Care Survey, we assessed how frequently physicians caring for pregnant women identified pregnant women's smoking status and provided counseling to pregnant smokers. Data were available from 793 physicians reporting on 5,622 office visits by pregnant patients from 1991 through 1996. Physicians identified pregnant women's smoking status at 81% of visits but provided smoking counseling at only 23% of visits by pregnant smokers. Physicians were less likely to identify smoking status of non-White pregnant women but no less likely to counsel non-White smokers. These results indicate a clear need to improve quality of care provided to pregnant women who use tobacco.