Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Evidence Tools
MCH Best. NPM 14.1: Smoking in Pregnancy

MCH Best Logo paper cutout people holding a used cigarette

Strategy. Multicomponent Psychosocial

Approach. Use a multicomponent standard smoking cessation package for pregnant women.

Return to main MCH Best page >>

Overview. Research indicates that smoking cessation counseling is an effective public health intervention to help pregnant smokers quit.1,2 A multicomponent smoking cessation package known as the 5A’s whereby trained providers deliver brief counseling to help clients quit smoking is impactful. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) can serve as a venue for delivering the 5A’s to increase perinatal smoking cessation and improve maternal and infant health outcomes.3 Home visitors can also use a multicomponent package of smoking cessation strategies such as education, motivational interviewing, and referral to smoking cessation resources.4

Evidence. Moderate. There is strong evidence that a multicomponent psychosocial smoking cessation package can decrease 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. Health care providers caring for pregnant women. Pregnant women who smoke.

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 “Use a multicomponent standard smoking cessation package for pregnant women,” here are sample ESMs you can use to 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 staff trained to deliver a multicomponent package of smoking cessation strategies such as education, motivational interviewing, and referral to smoking cessation resources

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

  • Percent of staff trained to deliver multicomponent package of smoking cessation strategies such as education, motivational interviewing, and referral to smoking cessation resources.

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

  • Number of pregnant women who quit or reduce smoking after receiving smoking cessation support.

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

  • Percent of pregnant women who quit or reduce smoking after receiving smoking cessation support.

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 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 Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2009;8(3):CD001055.

3 Olaiya O, Sharma AJ, Tong VT, Dee D, Quinn C, Agaku IT et al. Impact of the 5As brief counseling on smoking cessation among pregnant clients of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics in Ohio. Preventive Medicine: An International Journal Devoted to Practice and Theory 2015;81:438-43.

4 Griffis H, Matone M, Kellom K, Concors E, Quarshie W, French B, Rubin D, Cronholm PF. Home visiting and perinatal smoking: a mixed-methods exploration of cessation and harm reduction strategies. BioMed Central Public Health 2016 Aug 11;16(1):764. doi: 10.1186/s12889-016-3464-4.

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.