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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. Social Support (Pregnancy)

Approach. Provide social support for quitting smoking during pregnancy

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Overview. Research indicates that smoking cessation campaigns that are adapted to specific population groups have been found to be well-received and prompt quit attempts. For example, indigenous community health workers, called Aunties, can reach and mobilize American Indian women to promote access to health care programs and deliver cessation support for social support early in pregnancy.[1] Social support for quitting via a “quitpal” has also been combined with health education using standard smoking cessation text messages to support pregnant women with promising results.[2]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential 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:

  • Enrollment and participation data in smoking cessation programs
  • Survey data on social support components integrated into programs
  • Participant survey and feedback

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).
  • 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. 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 community health workers trained to provide appropriate cessation support. (Measures workforce development)
  • Number of pregnant women who smoke paired with a designated support person for ongoing encouragement. (Measures reach of social support intervention)

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

  • Percent of quitpal contacts that include key elements of supportive communication, such as expressing empathy and avoiding judgment. (Measures quality of support delivery)
  • Percent of community health workers demonstrating proficiency in motivational interviewing techniques after training. (Measures skill development)

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

  • Number of pregnant women who smoke who report that social support increased their confidence in being able to quit following their engagement with community health workers. (Measures impact on self-efficacy)
  • Percent of pregnant women who feel then tailored support from community health workers helped them develop effective coping strategies for managing smoking triggers. (Measures skill acquisition)
  • Number of pregnant women who smoke who make a 24-hour quit attempt with the assistance of their community health worker for support person. (Measures initial behavior change)
  • Number of individuals who remain smoke-free at 6 months postpartum, crediting their community health worker for support person as a key factor in their success. (Measures long-term impact)

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

  • Percent of community health workers recruited from communities with the highest rates of smoking during pregnancy. (Measures workforce representativeness)
  • Percent of community input sessions on the social support strategy that include representation from pregnant women experiencing economic challenges. (Measures impact of program planning)
  • Percent reduction in smoking prevalence during pregnancy among groups with historically high rates of maternal smoking. (Measures impact on reducing negative health outcomes)
  • Percent decrease in the difference in adverse birth outcomes between pregnant women who smoke receiving and not receiving social support, stratified by demographic variables. (Measures impact on birth outcomes)

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 Glover M, Kira A, Smith C. Enlisting “Aunties” to support indigenous pregnant women to stop smoking: Feasibility study results. Nicotine & Tobacco Research 2016;18:1110-5.

2 Abroms LC, Johnson PR, Heminger CL, Van Alstyne JM, Leavitt LE, Schindler-Ruwisch JM, Bushar JA. Quit4baby: results from a pilot test of a mobile smoking cessation program for pregnant women. Journal of Medical Internet Research Mhealth Uhealth. 2015 Jan 23;3(1):e10. doi: 10.2196/mhealth.3846.

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.