Evidence Tools
NPM 14
Smoking
Significance
The Title V Maternal and Child Health Services Block Grant to States Program guidance defines the significance of this goal as follows:
Women who smoke during pregnancy are more likely to experience a fetal death or deliver a low birth weight baby. Further, secondhand smoke (SHS) is a mixture of mainstream smoke (exhaled by smoker) and the more toxic side stream smoke (from lit end of nicotine product) which is classified as a "known human carcinogen" by the US Environmental Protection Agency, the US National Toxicology Program, and the International Agency for Research on Cancer. Adverse effects of parental smoking on children have been a clinical and public health concern for decades and were documented in the 1986 U.S. Surgeon General Report.
The only way to fully protect non-smokers from indoor exposure to SHS is to prevent all smoking in the space; separating smokers from non-smokers, cleaning the air, and ventilating buildings do not eliminate exposure. Unfortunately, millions (more than 60%) of children are exposed to SHS in their homes. These children have an increased frequency of ear infections; acute respiratory illnesses and related hospital admissions during infancy; severe asthma and asthma-related problems; lower respiratory tract infections leading to 7,500 to 15,000 hospitalizations annually in children under 18 months; and sudden infant death syndrome (SIDS). Higher intensity medical services are also required by children of parents who smoke including an increased need for intensive care unit services when admitted for flu, longer hospital stays; and more frequent use of breathing tubes during admissions.
NPM 14 Tools
NEW! The MCH Evidence Center is pleased to share Phase 1 of the MCHbest database: the Bank of Evidence-linked Strategies and Tools.
The database aggregates sample evidence-based/informed strategies that can be used as-is or adapted to develop Evidence-based or informed Strategy Measures (ESMs) for each of the MCH National Performance Measures (NPMs). Use the database along with the ESM Development Guide to work through the entire ESM process.
NEW! Watch a short video (below) discussing state-of-the-art, evidence-based/informed strategies that can be used or adapted as ESMs. Experts in the field discuss approaches, the science, and specific ways that Title V agencies can implement and measure these approaches.
Other New Resources:
- NPM 14.1 Smoking in Pregnancy - Evidence Review: Brief. A summary of report methodologies, results, key findings, and implications.
- NPM 14.1 Smoking in Pregnancy - Evidence Review: Full Report. A critical analysis and synthesis of the effectiveness of strategies that might be applied to address NPM 14.2 to serve as the foundation for accountability across all states and jurisdictions.
- NPM 14.2 Smoking in the Household - Evidence Review: Brief. A summary of report methodologies, results, key findings, and implications.
- NPM 14.2 Smoking in the Household - Evidence Review: Full Report. A critical analysis and synthesis of the effectiveness of strategies that might be applied to address NPM 14.2 to serve as the foundation for accountability across all states and jurisdictions.
- Smoking Timeline. With widespread documentation of the adverse health effects of active smoking in the 1960s, attention turned to the exposure of nonsmokers and the possibility of serious health effects. This timeline traces the public health response to the smoking crisis.
Strategy Video
Presented by Beth DeFrancis, American College of Obstetricians and Gynecologists
Webinar 4: NPM 14, Smoking from NCEMCH on Vimeo.
Introductory Resources
- Evidence Brief (National Center for Education in MCH (NCEMCH) at Georgetown University).
- Environmental Scan (Women's and Children's Health Policy Center (WCHPC) at Johns Hopkins University). This environmental scan identifies compilations of strategies to advance NPM 14. Read more about environmental scans.
- Smoking Timeline. With widespread documentation of the adverse health effects of active smoking in the 1960s, attention turned to the exposure of nonsmokers and the possibility of serious health effects. This timeline traces the public health response to the smoking crisis.
Summary of the Evidence
The following trends emerged from analysis of peer-reviewed evidence. While findings might not completely align with your ESM, they can serve as ideas for future expansion.
Key Findings for NPM 14.1: Smoking in Pregnancy
| Setting | Intervention Type | Intervention Strategy | Evidence Rating |
|---|---|---|---|
| Clinic-based | Incentive | Financial incentives and vouchers to enhance smoking abstinence in a multicomponent standard smoking cessation package for pregnant women | Moderate evidence |
| Counseling | Enhanced adult smoking cessation program with motivational interviewing targeting pregnant women | Moderate evidence | |
| Multicomponent psychosocial | Multicomponent standard smoking cessation package for pregnant women embedded into Women, Infants, and Children (WIC) prenatal care clinic services | Moderate evidence | |
| Pharmacotherapy | NRT + multicomponent standard smoking cessation package for pregnant women | Moderate evidence | |
| Health care provider training | Health care provider training including maternity staff, administrators and smoking cessation counselors; or midwives | Moderate/Emerging evidence | |
| Automatic initiation of smoking cessation program | Biochemical verification or electronic health records used to automatically opt in pregnant smokers to smoking cessation program | Emerging evidence | |
| Feedback | Indoor air quality measurement feedback + multicomponent standard smoking cessation package for pregnant women | Emerging evidence | |
| Exercise | Exercise + multicomponent standard smoking cessation package for pregnant women | Evidence against | |
| Electronic | Health education | Standard motivational text messages added to support standard multicomponent smoking cessation program for pregnant women | Moderate evidence |
| Health education + Incentives | Standard smoking cessation text messages specific to pregnant women + monetary incentives/gift vouchers to complete follow up at 1, 3 and 6 months | Moderate/Emerging evidence | |
| Health education + Social support | Standard smoking cessation text messages with limited interaction for support to pregnant women + social support for quitting via a “quitpal” | Emerging evidence | |
| Counseling | Telephone, internet platform or text application to deliver individual counseling support for smoking cessation | Emerging evidence | |
| Counseling + Incentives + Feedback | Web-based, incentive-based contingency management program + phonedelivered cessation counseling + feedback based on breath CO results | Emerging evidence | |
| Journaling | Online journaling platform to support smoking cessation for pregnant women | Emerging evidence | |
| Community-based | Multicomponent psychosocial | Home visitors use smoking cessation strategies (education, motivational interviewing, referral to smoking cessation resources) during home visiting program visits | Moderate evidence |
| Counseling | Trained midwives to provide smoking cessation counseling with standard smoking cessation package to pregnant women and household members in home-based care | Emerging evidence | |
| Social support | Using voluntary community members as community support workers to deliver in-person, culturally appropriate multicomponent smoking cessation package to pregnant women | Emerging evidence | |
| Population-based | Policy | National, state or local anti-smoking campaigns or regulations to increase smoke-free environments | Mixed evidence |
Key Findings for NPM 14.2: Smoking in the Household
| Setting | Target Audience | Intervention Type | Intervention Strategy | Evidence Rating |
|---|---|---|---|---|
| Community-based | Well-child | Multicomponent counseling-based intervention | In-person counseling (A) + educational materials (B) + telephone counseling/ follow-up (C) + home visits (D) | Moderate evidence |
| In-person counseling (A) + educational materials (B) + telephone counseling/ follow-up (C) + home visits (D) + cotinine and/or SHSe (air quality) feedback | Emerging evidence | |||
| In-person counseling (A) + educational materials (B) + home visits (D) + air purifiers in the home (H) | Emerging evidence | |||
| Multicomponent education-based intervention | In-person counseling (A) + home visits (D) | Emerging evidence | ||
| Community-based | Ill-child | Multicomponent counseling-based intervention | In-person counseling (A) + educational materials (B) + home visits (D) | Mixed evidence |
| In-person counseling (A) + telephone counseling/follow-up (C) + home visits (D) + cotinine level and/or SHSe (air quality) feedback (E) + NRT and/or information/access (F) | Emerging evidence | |||
| Clinic-based | Well-child | Multicomponent counseling-based intervention | In-person counseling (A) + educational materials (B) | Mixed evidence |
| In-person counseling (A) + educational materials (B) + telephone counseling/ follow-up (C) | Mixed evidence | |||
| In-person counseling (A) + educational materials (B) + NRT and/or information/ access (F) + EHR prompt and referral (J) | Emerging evidence | |||
| In-person counseling (no additional components) intervention | In-person counseling (A) | Moderate evidence/ Mixed evidence | ||
| Multicomponent education-based intervention | Educational materials (B) + cotinine levels (air quality) and/or SHSe feedback (E) +/- telephone counseling/follow-up (C) | Emerging evidence | ||
| Clinic-based | Ill-child | Multicomponent counseling-based intervention | In-person counseling (A) + educational materials (B) + telephone counseling/ follow-up (C) | Emerging evidence |
| In-person counseling (no additional components) | In-person counseling (A) | Emerging evidence | ||
| Multicomponent education-based intervention | Educational materials (B) + telephone counseling/follow-up (C) + cotinine level and/or SHSe (air quality) feedback (E) | Emerging evidence/ Mixed evidence |
Evidence Analysis Reports
- NPM 14.1 Percent of women who smoke in pregnancy
- Evidence Review: Brief. A summary of report methodologies, results, key findings, and implications.
- Evidence Review: Full Report. A critical analysis and synthesis of the effectiveness of strategies that might be applied to address NPM 14 to serve as the foundation for accountability across all states and jurisdictions. The evidence review uses a structured approach to evaluate the available empirical evidence and to draw conclusions for MCH programs based on the best available evidence.
- NPM 14.2 Percent of children, ages 0 through 17, who live in households where someone smokes
- Evidence Review: Brief. A summary of report methodologies, results, key findings, and implications.
- Evidence Review: Full Report. A critical analysis and synthesis of the effectiveness of strategies that might be applied to address NPM 14 to serve as the foundation for accountability across all states and jurisdictions. The evidence review uses a structured approach to evaluate the available empirical evidence and to draw conclusions for MCH programs based on the best available evidence.
- Read about the evidence analysis report methodology | You can also access the full set of Evidence Analysis Reports.
Promising Practices
You can access strategies from AMCHP’s Innovation Station that have shown promise in advancing your NPM below. While these strategies may not completely align with your current activities, they can be used to help guide further development and measurement of your ESM.
| Practice Name | Primary Interest | State | Level of Evidence |
|---|---|---|---|
| Super Babies Program | Birth Defects Prevention | MN | Emerging |
| Healthy Babies are Worth the Wait | Birth Outcome | KY | Best |
| One Tiny Reason to Quit | Smoking/Tobacco Cessation | VA | Promising |
| The Missouri Model for Brief Smoking Cessation Training | Smoking/Tobacco Cessation | MO | Emerging |
| Parent Child Assistance Program (PCAP) | Substance & Tobacco Use | WA | Best |
| First 5 California Kit for New Parents | Family/Consummer Involvement | CA | Promising |
| Early Intervention Partnerships Program | Health Screening | MA | Emerging |
| Nurse Family Partnership | Home Visiting | National | Best |
| NV Title V Maternal Child Health Program Perinatal Substance Use | Substance and Tobacco Use | NV | Cutting Edge |
| Florida Infant Risk Screening Tool | Infant Health | FL | Promising |
| Partners in Pregnancy | Infant Health | VA | Promising |
| Baby and Me Tobacco Free | Substance & Tobacco Use | National | Best |
| Florida Infant Risk Screening Tool | Infant Health | FL | Promising |
| Women Together for Health | Overweight/Obesity | AZ | Emerging |
| Tampa Bay Doula Program | Perinatal Health | FL | Emerging |
| MotherWoman | Perinatal Health | MA | Promising |
| Internal Care Program | Preconception Health | AZ | Promising |
Sample ESMs
Domain and National Performance Measure: A. Percent of women who smoke during pregnancy and B. Percent of children who live in households where someone smokes
| Strategy [Source] | Evidence-based/-informed Strategy Measure (ESM) |
|---|---|
| Promote increased use of state-funded quitline [3] | # of calls received by smoking quitline in the past year |
| Increase the number of local communities with tobacco control laws and ordinances [3,4] | #/% of local communities with tobacco control laws and ordinances |
| Partner with WIC to promote smoking cessation among pregnant and postpartum women [3,4] | #/% of WIC sites implementing evidence-based 5As screening tool and referring pregnant and postpartum women to smoking cessation services |
| Implement smoking cessation programs such as Baby & Me Tobacco Free Program and Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Program in local jurisdictions [4] | # of local jurisdictions with a formal smoking cessation program for pregnant and postpartum women |
[3] Women’s and Children’s Health Policy Center, Johns Hopkins Bloomberg School of Public Health. Environmental Scans.
[4] Association of Maternal and Child Health Programs & Johns Hopkins Bloomberg School of Public Health. Taking Action with Evidence: Implementation Roadmap Webinars.
Source: Sample Strategies and Evidence-based/informed Strategy Measures (ESMs) (WCHPC). A list of sample strategies and ESMs for each of the 15 NPMs. Sources are provided at the end of the document.
Related ESMs. You can access ESMs being implemented by other states/jurisdictions that may serve as models for NPM 14.
Additional Learning
- NPM 14 Transformation Tools (MCH Navigator and National MCH Workforce Development Center). Learning resources, implementation strategies, and links to the evidence base for the competencies needed to carry out NPM 14 activities.
- Taking Action with Evidence Implementation Roadmap (Association of MCH Programs (AMCHP) and WCHPC). Archived webinars and additional learning and implementation resources.
- Historical Resources from the MCH Digital Library (NCEMCH). This bibliography is automatically generated to pull resources from MCHLine, the MCH Library's online catalog of seminal resources, in support of NPM 14. Coming soon.
Additional Resources
- Data Resource Center for Child and Adolescent Health (DRC): A project of the Child and Adolescent Health Measurement Initiative, the DRC is a national data resource providing easy access to children’s health data on a variety of important topics, including the health and well-being of children and access to quality care.