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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Smoking During Pregnancy.

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Strategy. Health Education (Pregnancy)

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 defined as those where women are provided with information about the risks of smoking and advice to quit, but are not given further support for advice about how to make this change. Interventions where the woman was provided with automated support such as self-help manuals for automated text messaging, but there was no personal interaction at all are considered health education interventions.[1] Health education has been combined with monetary incentives/gift vouchers,3 for social support for quitting via a “quitpal”[4] with efficacy.

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Survey data on reach and engagement with educational activities
  • Data on content and delivery of health education
  • Survey data on short-term changes in knowledge and attitudes

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Morbidity Reduction. This strategy addresses factors that can decrease the incidence or prevalence of diseases and illnesses.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of prenatal care providers delivering smoking cessation health education. (Measures provider engagement in intervention)
  • Number of community touchpoints (e.g., WIC clinics, birthing classes) providing cessation information. (Measures community-based education efforts)

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

  • Percent of health education materials aligned with national best practice guidelines. (Measures quality of educational content)
  • Percent of health education content available in the a variety of languages. (Measures linguistic usability)

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

  • Number of regional perinatal health coalitions promoting unified cessation health education messages. (Measures collaborative messaging efforts)
  • Number of joint initiatives disseminating cessation education in housing, employment, for food assistance programs. (Measures cross-sector partnerships)
  • Number of pregnant women who reduced their smoking within 2 months of starting health education. (Measures short-term behavior change)
  • Number of individuals who quit smoking by delivery and credit health education as a key motivator. (Measures long-term impact of education)

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

  • Percent of health education recipients who live in areas with the highest smoking prevalence. (Measures tailored outreach to communities facing significant smoking-related health challenges)
  • Percent of cessation health education funding dedicated to tailored campaigns for populations experiencing greatest needs. (Measures focused resource allocation)
  • Percent decrease in NICU admissions for infants of individuals who received smoking cessation education. (Measures impact on birth outcomes)
  • Percent of pregnant women who smoke reporting increased knowledge of cessation benefits and strategies. (Measures impact on health)

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.
  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.

References

1 Forinash, A. B., Yancey, A., Chamness, D., Koerner, J., Inteso, C., Miller, C., Gross, G. & Mathews, K. (2018). Smoking cessation following text message intervention in pregnant women. Annals of Pharmacotherapy, 52(11), 1109-1116.

2 Abroms, L. C., Chiang, S., Macherelli, L., Leavitt, L., & Montgomery, M. (2017). Assessing the National Cancer Institute’s SmokefreeMOM text-messaging program for pregnant smokers: pilot randomized trial. Journal of Medical Internet Research, 19(10), e333.

3 Abroms, L. C., Johnson, P. R., Leavitt, L. E., Cleary, S. D., Bushar, J., Brandon, T. H., & Chiang, S. C. (2017). A randomized trial of text messaging for smoking cessation in pregnant women. American journal of preventive medicine, 53(6), 781-790.

4 Abroms, L. C., Johnson, P. R., Heminger, C. L., Van Alstyne, J. M., Leavitt, L. E., Schindler-Ruwisch, J. M., & Bushar, J. A. (2015). Quit4baby: results from a pilot test of a mobile smoking cessation program for pregnant women. JMIR mHealth and uHealth, 3(1), e3846.

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.