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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. NPM 14.1: Smoking in Pregnancy

MCHbest Logo paper cutout people holding a used cigarette

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:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of pregnant women who receive counseling during prenatal clinic visits and/or home visits to quit smoking.
  • Number of pregnant women who receive individualized, motivational text messages to quit smoking.
  • Number of providers/educators/home visitors trained to deliver tobacco cessation counseling to pregnant women.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of pregnant women who report high levels of satisfaction with the counseling received.
  • Percent of providers referring pregnant women for tobacco cessation counseling services.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of pregnant women who report increased knowledge of the adverse effects of smoking during pregnancy.
  • Number of pregnant women who report new and positive attitudes about quitting smoking due to the support received.
  • Number of pregnant women who report a readiness to quit smoking because of counseling.
  • Number of pregnant women who report using a referral for additional tobacco cessation services.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of pregnant women who quit or reduce smoking due to counseling.
  • Percent of women who remain smoke-free into the postpartum period due to counseling.

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). Addiction112(7), 1238-1249.

3 Bailey, B. A. (2015). Effectiveness of a pregnancy smoking intervention: the Tennessee intervention for pregnant smokers program. Health Education & Behavior42(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 medicine51(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 medicine38, 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.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.