S.M.A.R.T. Mothers Are Resisting Tobacco: Prenatal Smoking Cessation in WIC Mothers

By Edwards, Martha Jo; Geiser, Terri et al. | Journal of Allied Health, Fall 2009 | Go to article overview

S.M.A.R.T. Mothers Are Resisting Tobacco: Prenatal Smoking Cessation in WIC Mothers


Edwards, Martha Jo, Geiser, Terri, Chafin, Cynthia, Weatherby, Norman L., Smith, Carol M., Journal of Allied Health


This article presents outcomes of the Smart Mothers Are Resisting Tobacco (S.M.A.R.T. Moms) project, a "5 A's"-based, best-practices intervention for prenatal smoking cessation targeting primarily pregnant WIC patients in Tennessee. Evidence-based training using "5 A's" materials were provided to health care providers. Providers in turn counseled patients on smoking cessation and provided individual cessation treatment plans with educational information and materials. At the conclusion of the 4-year project, 13,285 patients had received counseling and smoking cessation resources through the project. The overall success rate for participants who received counseling and agreed to use the self-help guide was 24.2% vs 20.9% for those who did not choose to use the self-help guide but did receive counseling, exceeding success rates previously found in similar settings. The outcomes of this project support research that even brief tobacco cessation counseling (5 to 15 min), delivered by trained providers and coupled with pregnancy-specific self-help materials, can increase cessation rates in women during pregnancy. Outcomes from this project also support that, when provided with adequate training and pregnancy-specific self-help materials, health care providers will more consistently counsel patients on smoking cessation during pregnancy. J Allied Health 2009; 38:170-176.

PREGNANT SMOKERS represent a major public health challenge. Despite the Surgeon General's warnings about the dangers of tobacco use during pregnancy, a significant numbet of women continue to smoke during pregnancy. Tennessee has one of the highest rates of smoking and smoking-related deaths in the country and it is one of only five states that spent $0 on tobacco prevention during 2007. 1 Nationally, 1 1.4% of pregnant women in the US are identified as smokers,2 whereas the rate in Tennessee is 17.1%,3 the second highest in the nation. This rate is estimated to be even highet fot pregnant women who are socially disadvantaged, including women who ate covered by Medicaid4 and those who are unmarried, unemployed, or have less than a high school education.5 In 2005, 27,900 women received Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits. Of all pregnant WIC patients, 29.3% smoked, and in 5 out of 14 regions of Tennessee, the percentage of pregnant women who smoked ranged from 32% to 38%.6

Smoking is the single most important modifiable cause of poor pregnancy outcomes in the US.7 Studies have shown that between 25% and 60% of pregnant smokers quit smoking spontaneously when they learn they are pregnant.8-13 Smoking during pregnancy has been shown to contribute to adverse outcomes including miscarriage, placental abruption and separation, premature rupture of membranes, preterm delivery, low birth weight, increased prenatal mortality, still birth, and sudden infant death syndrome (SIDS).14-15 Economic estimates indicate that the direct medical costs of a complicated birth for a smoker are 66% higher than for a nonsmoker.16 It is estimated that in 1996 smoking-attributable neonatal expenditures accounted for $366 million in the US.17

Health care providers have compelling reasons to help pregnant women and mothers quit smoking. Many female smokers are motivated to stop smoking when they find out ttiey are pregnant. Smoking cessation provides immediate and long-term benefits for pregnant women and their young children. The US Surgeon General reported that infants of women who quit smoking by the third trimester weighed more than infants of women who continued to smoke throughout pregnancy. While quitting early in pregnancy is best, health benefits can be achieved from cessation at any time before delivery.18 Quit rates using "best practice" interventions are 14% to 16% versus 5% to 6% achieved with usual care.19

The Smart Mothers Are Resisting Tobacco (S.M.A.R.T. Moms) project is a statewide collaboration among Middle Tennessee State University, the Tennessee Department of Health, and the March of Dimes Tennessee chapter designed to educate pregnant women about the dangers of smoking and provide them with counseling from trained health care providers. …

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