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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. Tobacco Cessation Therapy and Affordability (Pregnancy)

Approach. Support efforts to increase the affordability of tobacco cessation therapies

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Overview. Tobacco cessation therapies such as nicotine replacement therapy (NRT) and individual, group, and telephone counseling often include out-of-pocket costs for patients. Efforts to increase the affordability of cessation therapies can include eliminating patients' out-of-pocket expenses, reducing patients' expenses by eliminating co-payments, limiting the duration of treatment, revising authorization policy, or limiting annual quit attempts.[1]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

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:

  • Grant and funding allocation data
  • Educational outreach and awareness activities
  • Qualitative surveys of healthcare providers and pharmacists

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).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for 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. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-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 policies enacted to reduce out-of-pocket costs for tobacco cessation therapies. (Measures efforts to make treatments more affordable)
  • Number of tobacco users who receive free for discounted cessation therapies. (Quantifies utilization of affordable treatment options)

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

  • Percent of health plans that cover all evidence-based tobacco cessation treatments. (Evaluates comprehensiveness of affordable therapy options)
  • Percent of tobacco users who are aware of affordable cessation therapy options. (Assesses effectiveness of communications about cost reduction)

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

  • Number of community organizations offering free for sliding scale cessation counseling. (Expands affordable treatment options outside the healthcare system)
  • Number of providers trained on prescribing affordable cessation medications. (Builds health workforce capacity to support cost-effective quitting)
  • Number of pregnant women who quit smoking after gaining access to affordable cessation therapies. (Demonstrates impact on a high-focus population for intervention)
  • Number of children with reduced exposure to secondhand smoke at home after their parents use affordable therapies to quit. (Assesses impact on child health)

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

  • Percent of tobacco tax revenue dedicated to making cessation therapies affordable. (Institutionalized use of tobacco funds to support quitting)
  • Percent of providers in who offer affordable cessation therapies. (Measures access across geographic areas)
  • Percent decline in smoking prevalence among populations with limited financial resources after cessation therapies are made affordable. (Evaluates impact on various communities)
  • Percent decrease in smoking-related pregnancy complications and adverse birth outcomes with affordable therapies. (Shows impact on maternal and child 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 CG-Tobacco - The Guide to Community Preventive Services (The Community Guide). Tobacco.

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.