Teamwork Makes the Dream Work: How State Public Health Programs can Collaborate to Support and Implement Best Practices for Tobacco Cessation Among Pregnant Women Year 1 Successes and Lessons Learned

Full Description: Despite scores of evidence and public health messaging, Iowa continues to have a tobacco and nicotine use problem among pregnant/postpartum women. According to Iowa vital statistics data in 2020, 7.8% of newborns in Iowa were born to mothers who smoked cigarettes compared to 6.5% nationally. These newborns were 1.7 times more likely to be low birth weight and 34% more likely to be born preterm. Among pregnant mothers who report smoking in Iowa, 54% were enrolled in WIC services. According to the PRAMS, 20% of women were not advised to quit by their healthcare provider.
Given these data and needs assessment, Iowa’s Title V program included NPM 14a percent of women who smoke during pregnancy. The Division of Tobacco Use Prevention and Control (TUPC) began to focus on educating women of reproductive age, and training providers on the harmful effects of tobacco use as well as tobacco cessation programs provided by the state including Quitline Iowa and Ask, Advise, Refer (AAR). The I-Smile Program began efforts within NPM 13.1 to educate and inform maternal health clients of the harmful oral health effects from using tobacco and utilizing the Quitline Iowa resources.
The TUPC brought partners from across IDPH together to discuss ways to align our efforts and messaging to bring cohesiveness and agency- wide support to the effort. This project was facilitated by the collaboration of the TUPC along with the Title V, WIC, Title X, and Home Visitation (MIECHV) programs to identify key stakeholders and partners to reduce the maternal smoking rate in Iowa.
We identified 3 phases to implement this initiative. We surveyed multiple stakeholder groups including IDPH programs and external stakeholders to inform where needs lie.
Phase 1 included working with Quitline Iowa to implement an incentive pregnancy program. This program included providing participants with pregnancy specific materials, dedicated female quit coaches, 9 coaching calls, and monetary incentives after coaching calls have been completed including postpartum calls. At this point, local Title V maternal health agencies and I-Smile programs were referring to Quitline Iowa and were beginning to collaborate with their local community tobacco coalitions and organizations, though the referrals were very minimal.
Phase 2 included educating and training Title V, WIC, Title X, and Home Visitation (MIECHV) contractors on Quitline Iowa’s AAR program to enroll pregnant women who smoke into the Pregnancy Program. Train health professionals how to support pregnant women working on tobacco cessation. Attending 6 Title V MCAH regional meetings throughout the state to train on AAR and motivational interviewing as well as I-Smile, WIC, Title X and MIECHV conferences and trainings.
Targeted Audience Reach By Program:
10,381 Home Visiting clients
5,584 Title V clients
31,439 Title X clients
10,992 WIC clients
Phase 3 begins in 2022 using lessons learned from phase 2 to work with external stakeholders.

Abbreviated Description: In 2019, the Iowa Department of Public Health (IDPH) Tobacco Use Prevention and Control Division along with Maternal Child and Adolescent Health (MCAH) Title V, I-Smile™, WIC, and Home Visitation programs (MIECHV) collaborated to implement a statewide pregnancy cessation training program. Engaging and training state public health programs who work with women of reproductive age on how to successfully refer pregnant women to cessation programs is critical to the sustainability of these programs.