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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. Multicomponent Psychosocial (Pregnancy)

Approach. Use a multicomponent approach to increase smoking cessation among pregnant women

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Overview. Since many smoking-cessation strategies involve multiple interventions that are tailored to individual women, it is difficult to assess the independent effect of the individual components.[1] Many interventions that support pregnant women are multimodal. Counseling, feedback, and incentive components are likely to help reduce smoking among pregnant women. The evidence for health education, exercise, social support, and other components is less clear

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:

  • Data on implementation fidelity and adherence
  • Satisfaction and engagement data
  • Data on cost-effectiveness and resource utilization

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.

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. Counseling (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 WIC clinics and home visiting programs implementing the 5 A's smoking cessation package. (Measures adoption of intervention)
  • Number of providers completing training on the 5A's brief counseling model. (Measures workforce development)

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

  • Percent of 5A's delivery sessions lasting the recommended 15 minutes for more. (Measures fidelity to intervention model)
  • Percent of providers demonstrating proficiency in all 5A's steps after training. (Measures provider competency)

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

  • Number of memoranda of understanding established between 5A's providers and smoking cessation resources. (Measures partnership development)
  • Number of WIC clinics with a designated smoking cessation champion to support 5A's sustainability. (Measures organizational commitment)
  • Number of individuals who attempt to quit smoking within 2 months of starting the 5A's intervention. (Measures short-term behavior change)
  • Number of pregnant women who maintain abstinence at a 1-month post-intervention follow-up. (Measures sustained behavior change)

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

  • Percent of 5A's providers serving communities with the highest smoking prevalence among pregnant women. (Measures distribution of services)
  • Percent of 5A's counseling sessions delivered in a client's language. (Measures usability)
  • Percent reduction in smoking during pregnancy among individuals enrolled in Medicaid receiving 5A's counseling. (Measures impact)
  • Percent of pregnant women who smoke who progress in readiness to quit after each 5A's session. (Measures impact on quit readiness)
  • Percent of participants reporting high satisfaction with the helpfulness of the counseling. (Measures perceived value of intervention)

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 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 Breunis, L. J., de Kroon, M. L. A., de Jong-Potjer, L. C., Steegers, E. A. P., & Been, J. V. (2023). Piloting a complex intervention to promote a tobacco and alcohol-free pregnancy: the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study. BMC pregnancy and childbirth, 23(1), 19. https://doi.org/10.1186/s12884-022-05320-8

4 Petersen, A. B., Ogunrinu, T., Wallace, S., Yun, J., Belliard, J. C., & Singh, P. N. (2022). Implementation and Outcomes of a Maternal Smoking Cessation Program for a Multi-ethnic Cohort in California, USA, 2012-2019. Journal of community health, 47(2), 257–265. https://doi.org/10.1007/s10900-021-01042-8

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.