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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. Feedback

Approach. Provide feedback to support reduction or smoking cessation behaviors.

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Overview. Research indicates that using feedback incorporated into comprehensive smoking cessation interventions can enhance the reduction of smoking during pregnancy. Feedback interventions are those where a pregnant woman is provided information about the fetal health status or the results of measurement of tobacco smoking by-products to initiate or reinforce smoking cessation behaviors. This information includes ultrasound monitoring, and carbon monoxide or urine cotinine measurements, with the results shared at different points during a pregnancy.1

Evidence. Emerging. Initial research shown primarily positive results for this strategy, but further research is needed to confirm effects. The strategy of feedback 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. Currently no states or jurisdictions use ESMs that align with the feedback intervention strategy.

Sample ESMs. Using the approach “Provide feedback to support reduction or smoking cessation behaviors,” 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 home indoor air quality measurements during home visits to support their smoking cessation.

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

  • Percent of pregnant women who report they used indoor air quality measurements regularly to enhance their smoking cessation efforts.

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 a readiness to quit smoking.
  • Number of pregnant women who received feedback about their tobacco by-product measurement (CO levels; cotinine) to receive an incentive as part of their effort to quit smoking.

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

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

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 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.

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.