Smoking reduction activities in a federal program to reduce infant mortality among high risk women

Abstract

Objectives-To determine the smoking cessation/reduction services oVered to pregnant women by federally funded Healthy Start projects designed to reduce infant mortality. Design-Information was obtained by questionnaires sent to all Healthy Start projects in 1999. Responses were received from 76 sites. Setting-The federal government selected the Healthy Start sites on the basis of infant mortality rates that were much in excess of the national average. Patients-The projects served largely minority clients. Most of the women were poor and eligible for Medicaid. Main outcome measures-The services that projects oVered to pregnant smokers, the priority given the smoking related activities, and whether more should be done. Results-Only 23% of the sites thought that they were doing enough to help pregnant smokers stop or reduce smoking. The sites felt the national oYce should develop a manual of best practices, provide client materials, and organise workshops. While three quarters of the sites expected home visitors to counsel pregnant smokers, less than half provided training in this area during orientation, but most visitors received on-the-job training. Only 64% of sites gave smoking cessation/reduction activities high priority in comparison to other objectives of home visiting. Conclusions-Although Healthy Start sites were aware of the importance of smoking cessation/reduction activities for their clients, they oVered a limited range of services. These projects, and others with similar objectives serving similar populations, need a better understanding of the time and money such interventions require and greater belief in their eVectiveness, along with more funds, staV training and materials, and oYce systems that promote counselling. (Tobacco Control 2000;9(Suppl III):iii51-iii55)

A survey of pregnant smokers’ interest in different types of smoking cessation support

“…Those from a lower socio-economic bracket, as indicated by occupation, were more interested in 'buddying'. This may reflect a situation where women from more deprived socio-economic groups experience a deficit of social support [11] and therefore report an increased desire for additional support.…”

“…Yet, according to previous studies, rates of uptake of this type of support are low [8][9][10]. Previous reports suggest that the reasons given for poor uptake of behavioural smoking cessation support among pregnant smokers include lack of social support and inadequate childcare [11]. Further work is needed to more comprehensively identify the barriers to uptake of smoking cessation interventions among pregnant smokers and to design interventions which address these barriers.…”

“…There is some evidence for social support interventions ('buddy systems') increasing smoking abstinence rates in the general population [14] and lack of social support has been cited as the principle reason for poor attendance at smoking cessation sessions during pregnancy [11]. As yet there is very limited evidence for the benefits of the buddy system for pregnant smokers [15] and the level of interest in this approach has not been assessed for these women.…”

“…Despite the efficacy of behavioural support for smoking cessation during pregnancy a low level of uptake of this support has been cited as a major barrier to the implementation of such programmes [8][9][10][11]. A recent survey in the UK found that only around 5% of pregnant smokers make use of the behavioural support for smoking cessation which is available free in the National Health Service [9].…”

Smoking Cessation in Pregnancy: A Review of Postpartum Relapse Prevention Strategies

“…41 Many programs have piggybacked with programs such as Women, Infants, and Children; Medicaid; health maintenance organizations (HMOs), and other organized, standardized, prenatal programs. 6,42,43 Some people have tried more unusual methods of reaching pregnant smokers, for example through videotape, 42 digitally interactive programs, 38 and peer telephone support. 30 Most of these programs have combined intervention strategies, hoping to increase success rates.…”