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

OBJECTIVES To determine the smoking cessation/reduction services offered 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 offered 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 office 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 offered 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 effectiveness, along with more funds, staff training and materials, and office systems that promote counselling.