Evidence Tools
MCH Best. NPM 14.1: Smoking in Pregnancy
Strategy. Automatic Initiation of Smoking Cessation Program
Approach. Screen for tobacco use and automatically refer pregnant women who smoke to cessation services.
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Overview. Pregnant women who are screened for tobacco use and automatically referred for cessation services are more likely to quit smoking. Integrating tobacco cessation into standard clinical practice through “opt-out” assessment and referral programs is one way to ensure that these services are built into the provision of care for perinatal smokers. These involve identifying pregnant smokers using exhaled carbon monoxide (CO) or electronic health records and referring them for support. In opt-out programs, all patients receive services as part of routine standard of care unless they indicate refusal of services. Research indicates that “opt-out” referrals have the potential to improve engagement of pregnant smokers with smoking cessation support and to improve cessation outcomes.1,2
Evidence. Emerging. There is growing evidence that automatic initiation into smoking cessation programs is effective in reducing smoking during pregnancy. This 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. 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 “Use biochemical verification or electronic health records to automatically opt in pregnant smokers to smoking cessation programs,” 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:
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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 Buchanan C, Nahhas GJ, Guille C, Cummings KM, Wheeler C, McClure EA. Tobacco use prevalence and outcomes among perinatal patients assessed through an "opt-out" cessation and follow-up clinical program. Maternal and Child Health Journal 2017;21:1790-7.
2 Campbell KA, Cooper S, Fahy SJ, Bowker K, LeonardiBee J, McEwen A et al. 'Opt-out' referrals after identifying pregnant smokers using exhaled air carbon monoxide: Impact on engagement with smoking cessation support. Tobacco Control: An International Journal 2017;26:300-6.