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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 14.1: Smoking in Pregnancy

MCH Best Logo paper cutout people holding a used cigarette

Strategy. Health Education

Approach. Provide health education to reduce smoking during pregnancy.

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Overview. Research shows that health education can be effective in promoting smoking cessation during pregnancy. Health education interventions are those where women are provided with information about the risks of smoking and advice to quit, but are not given further support or advice about how to make this change. Interventions where the woman was provided with automated support such as self-help manuals or automated text messaging, but there was no personal interaction are considered health education interventions.1

Evidence. Emerging. Initial research shows positive results for this strategy, but further research is needed to confirm effects. The strategy of using health education 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.

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. There are currently 7 ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Provide health education 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 (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of pregnant women who receive health education (such as self-help materials, automated text messages) on the risks of smoking and advice to quit.

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

  • Percent of pregnant women who report that the health education received was convincing and that they want to quit or reduce smoking.

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

  • Number of pregnant women who report increased knowledge of the risks of smoking during pregnancy.
  • Number of pregnant women who incorporate text messages into a plan for quitting smoking.

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

  • Percent of pregnant women who quit or reduce smoking.
  • Percent of pregnant women or mothers who no longer permit smoking in the home.

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).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


1 Cummins SE, Tedeschi GJ, Anderson CM, Zhu SH. Telephone intervention for pregnant smokers: A randomized controlled trial.Am J Prev Med. 2016 Sep;51(3):318-26.

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.