Health Education for Pregnant Smokers

Evalation Design
A prospective randomized, pretestposttest control group design was implemented to assess midpregnancy and endof-pregnancy smoking status from selfreports and saliva cotinine tests. At the first visit and after the 994 patients gave their informed consent, a computer-generated system randomly assigned them to two groups: Experimental (E) Group (493 patients) and Control (C) Group (501 patients). After randomization, 93 E Group and 87 C Group patients became ineligible due towithdrawal from public health care, a miscarriage, or an abortion. A total of 814 pregnant smokers-400 E Group and 414 C Group patients-were eligible for follow-up.

Fonmative and Process Evaluation
The formative evaluation (noted above) was conducted at the four clinics with a sample of269 patients (100 smokers and 169 nonsmokers) recruited from 300 consecutive intakes. A 35% smoking rate (105/300) and a 10% refusal rate (31/300) was observed. The sample of 100 smokers served as a Historical Comparison Group (C Group) to document pretrial baseline prevalence rates and “normal” quit rates from the first visit to childbirth. Clinic nurses and administrators reviewed and field tested data and saliva collection methods with the 269 patients.

Focus group discussions were held with five to eight patients at each clinic to field test the E Group intervention. The interventionwas pilot tested to reestablish the feasibility of routinely providing cessation
methods and to confirm patient and provider acceptance. Intervention time and barriers to routine use were documented.

A process evaluation system was pilot tested with the 269 patients. Monthly, quarterly, and annual clinic reports were prepared to document implementation levels for intervention components and measurement procedures.

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