Pregnant women favor urine testing for tobacco cessation; clinicians express concern

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Up to one-third of female smokers with Medicaid deny tobacco use during pregnancy. A new study finds that, despite reservations, low-income patients have a favorable view of using urine testing, with consent, to promote smoking cessation during pregnancy. The study included 19 individual interviews and four focus groups with a total of 40 pregnant or postpartum women with Medicaid who smoked before or during pregnancy and 20 interviews with clinicians. Researchers collected patient urine samples using a test strip system which provides semi-quantitative detection of cotinine, a major nicotine byproduct. The majority of women interviewed (89 percent) strongly supported testing for tobacco use in pregnancy, but some feared the consequences of positive cotinine test results. Specifically, they were concerned about their clinician's reaction, potential violation of their privacy, and the involvement of government entities such as Child Protection Services. Women reported they would be more open to testing if clinicians described how the test could help them and their pregnancies. The majority of clinicians (more than 80 percent), were concerned that urine testing would have a negative impact on their relationship with patients. The authors call for research into the feasibility of consensual urine testing for tobacco use in the clinical setting. If increased testing leads to more patients getting support and counseling for tobacco cessation, they state, the benefits to public health could be enormous.

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Prenatal Point-of-Care Tobacco Screening and Clinical Relationships
Aisha Bobb-Semple, MD, et al
Icahn School of Medicine at Mount Sinai, New York, New York

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