
Evidence Tools
MCHbest. NPM 14.1: Smoking in Pregnancy


Strategy. Counseling
Approach. Provide counseling to reduce smoking during pregnancy.
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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, psychotherapy, relaxation, problem-solving facilitation, and other strategies.1,2,3,4,5
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 with motivational strategies in a step-by-step process.6
Evidence. Moderate. There is strong evidence that counseling is effective in reducing smoking during pregnancy. This strategy 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 and health care providers.
Outcomes. 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 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.
Sample ESMs. Using the approach “Provide counseling to reduce smoking during pregnancy,” here are sample ESMs you can use to model for your own measures using the Results-Based Accountability framework:
Quadrant 1:
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Quadrant 2:
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Quadrant 3:
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Quadrant 4:
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Note. When looking at your ESMs, SPMs, or other strategies: (1) move from measuring quantity to quality; (2) move from measuring effort to effect; (3) Quadrant 1 strategies should be used sparingly, when no other data exists; and (4) the most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.
Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.
Reference:
1 Chamberlain, C., O'Mara‐Eves, A., Porter, J., Coleman, T., Perlen, S. M., Thomas, J., & McKenzie, J. E. (2017). Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane database of systematic reviews, (2).
2 Naughton, F., Cooper, S., Foster, K., Emery, J., Leonardi-Bee, J., Sutton, S., ... & Coleman, T. (2017). Large multi‐centre pilot randomized controlled trial testing a low-cost, tailored, self-help smoking cessation text message intervention for pregnant smokers (MiQuit). Addiction, 112(7), 1238-1249.
3 Bailey, B. A. (2015). Effectiveness of a pregnancy smoking intervention: the Tennessee intervention for pregnant smokers program. Health Education & Behavior, 42(6), 824-831.
4 Cummins, S. E., Tedeschi, G. J., Anderson, C. M., & Zhu, S. H. (2016). Telephone intervention for pregnant smokers: a randomized controlled trial. American journal of preventive medicine, 51(3), 318-326.
5 Lee, M., Miller, S. M., Wen, K. Y., Hui, S. K. A., Roussi, P., & Hernandez, E. (2015). Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women. Journal of behavioral medicine, 38, 932-943.
6 Fiore M. C., Jaen C. R., Baker T. B., Bailey W. C., Benowitz N. L., Curry S. J., 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.