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Table 2 Smoking prevention in prenatal care in 2008 and 2018

From: Midwives’ engagement in smoking- and alcohol-prevention in prenatal care before and after the introduction of practice guidelines in Switzerland: comparison of survey findings from 2008 and 2018

VariablesNYear 2008 (N = 227)aYear 2018 (N = 300)aChi2dfp
n (%)n (%)
Risk perception: 1–2 cigarettes/day
 harmless for the child51948(21.5)20(6.8)47.9912< 0.001
 slightly risky for the child 152(68.2)182(61.5)   
 highly risky for the child 23(10.3)94(31.8)   
 Risk perception: 3–9 cigarettes /day
 harmless for the child5180(0.0)0(0.0)15.6951< 0.001
 slightly risky for the child 63(28.6)43(14.4)   
 highly risky for the child 157(71.4)255(85.6)   
Risk perception: 10 or more cigarettes /day
 harmless for the child5200(0.0)0(0.0)N/C  
 slightly risky for the child 0(0.0)0(0.0)   
 highly risky for the child 222(100)298(100)   
Risk perception: sudden cessation
 not risky for the child50997(44.1)102(35.3)5.27830.153
 slightly risky for the child509105(47.7)157(54.3)   
 highly risky for the child5095(2.3)13(4.5)   
 I don’t know50913(5.9)17(5.9)   
Risk perception: Passive smoking
 Environmental smoke is a risk521215(95.1)285(96.6)0.72210.395
  ‘it is rather harmless’ & ‘I don’t know’ 11(4.9)10(3.4)   
Screening: Routinely asking all women whether they smoke
 all women524202(89.4)266(89.3)0.66820.716
 only those suspected for smoking52422(9.7)27(9.1)   
  none5242(0.9)5(1.7)   
 Screening: Asking about exposure to passive smoking515123(54.4)134(46.4)3.29410.070
 Screening: Asking whether the partner smokes515152(67.3)178(61.6)1.76810.184
 Perceived importance of partner’s smoking (rather or very important)b520209(92.9)274(92.9)0.00010.997
 Routinely explaining to all women the risks of smoking for the child519145(64.4)155(52.7)7.18210.007
Stop smoking interventions with smokers
 Explaining the risks for the child526187(82.7)257(85.7)0.83710.360
 Repeatedly addressing smoking in consequent appointments526126(55.8)150(50.0)1.7110.191
 Assisting in elaboration of a plan to stop smoking52679(35.0)114(38.0)0.51410.473
 Providing information material to smokers52636(15.9)69(23.0)4.03310.045
 Referral to an expert52621(9.3)64(21.3)13.7941< 0.001
 Referral to behavioral therapy5269(4.0)16(5.3)0.5210.471
 Agreement to quit52615(6.6)11(3.7)2.42110.120
 Nicotine replacement therapy52612(5.3)22(7.3)0.87310.350
 no intervention52618(8.0)6(2.0)10.53110.001
Barriers: Reasons not to address smoking (rather or very true)c
 Shortage of time44520(9.6)34(14.3)2.32510.127
 I already know many of the women and their smoking habits from previous pregnancies47570(33.7)87(32.8)0.03610.850
 Most women already know the risks48698(46.7)116(42.0)1.04110.308
 Women with children are generally well informed about the risks48589(42.6)107(38.8)0.71910.396
 It is not within my area of responsibility4858(3.8)12(4.3)0.07110.790
 Uncertainty about clinical relevance of smoking47526(12.3)36(13.6)0.17810.673
 Uncertainty about being able to intervene effectively48368(32.4)89(32.6)0.00310.959
 Giving advice to smokers is not effective481107(51.2)124(46.0)1.30010.254
 Pregnant women probably do not honestly report on smoking48596(45.7)125(45.5)0.00310.955
 In vocational training I was not informed on the risks of smoking49044(20.8)60(21.6)0.04910.824
 Smoking in pregnancy is a matter of private life and should not be interfered with49016(7.6)9(3.2)4.71110.030
Advice given regarding smokingd:
 to quit523109(48.9)89(29.7)   
  “to quit” & “to reduce” NA144(48.6)   
 to reduce52390(40.4)61(20.3)   
 not to change5230(0.0)2(0.7)   
  1. aThe numbers of participants in analyses differ slightly due to missing values
  2. b The answers ranged from very important to very irrelevant on a 4-point scale, we merged them into two categories: ‘rather or very important’ that took 1 and ‘rather or very unimportant’ that took 0
  3. c The answers ranged from very true to very untrue on a 4-point scale, we merged them into two categories: ‘rather or very true’ that took 1 and ‘rather or very untrue’ that took 0
  4. d In the 2018 assessment, multiple responses were possible, i.e. midwives could indicate both ‘to quit’ and ‘to reduce’ as answers. Due to non-comparability of the response options, no statistical comparisons were conducted