MCHbest. NPM 14.1: Smoking in Pregnancy
Approach. Provide counseling to reduce smoking during pregnancy.
Overview. Research indicates that interventions using in-person or telephone-based counseling can be effective in reducing smoking during pregnancy. Counseling interventions are those which provide motivation to quit, support to increase problem solving skills, and may incorporate “transtheoretical” models of change. This includes interventions such as motivational interviewing, cognitive behavior therapy, other psychotherapies, relaxation, problem-solving facilitation, and other strategies.1
The Five A's of Smoking Cessation is considered the gold standard in cessation counseling: Ask - Advise - Assess - Assist - Arrange. The Five A;s is a brief counseling-based intervention, it can be combined wiht motivational strategies in a step-by-step process.2
Evidence. Emerging evidence. Initial research shows primarily positive results for this strategy, but further research is needed to confirm effects. The strategy of using counseling to reduce smoking during pregnancy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).
Target Audience. Pregnant women/health care providers.
Outcome. Smoking cessation during pregnancy. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.
Examples from the Field. Access descriptions of current ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.
North Carolina is collecting data on the number of women who receive tobacco cessation counseling by a care manager and/or home visitor. Texas is tracking the number of health care professionals trained on tobacco prevention and cessation interventions as it relates to the risks associated with maternal and infant exposure to tobacco.
The Role of Title V. Title V agencies can support cessation counseling for pregnant women by:
- Coordinating with public health partners who offer the cessation counseling programs. This will include coordination of services, collaboration of services, and convener of services.
For suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies.
Sample ESMs. Using the approach “Provide counseling to reduce smoking during pregnancy,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:
Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).
1 Chamberlain C, O-Mara-Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art No.: CD001055. https://doi.org/10.1002/14651858.CD001055.pub5.
2 Fiore MC, Jaen CR, Baker TB, Bailey WC, BenowitzNL, Curry SJ, et al. Treating tobacco use and dependence: 2008 Update. Clinical Practice Guidelines. 2008. U.S. Department of Health and Human Services, Public Health Service. Rockville, MD.