The percentage of pregnant smokers who register with the Quitline has remained relatively stable over time; yet, Vermont has one of the highest rates of smoking during pregnancy. Vermont’s rate of smoking during pregnancy is consistently   about   twice   the   national   rate: 16.8% of Vermont pregnant women smoke compared to 8.4% among U.S. women (2014 PRAMS). Further, the smoking rate among pregnant women who receive WIC assistance is nearly four times as high in Vermont as those who do not receive assistance (30.8% vs. 7.8%). In recent months, the Health Departments Divisions of Health Promotion and Disease Prevention, Maternal and Child Health, and Office of Local Health have turned their attention to this issue to try to bend the curve.  

VDH district office staff

Division of Health Promotion and Disease Prevention/Tobacco Control Program

Division of Maternal and Child Health

Vermont Center on Behavior and Health/University of Vermont

Home Health Agencies throughout Vermont

The evidence suggests that pregnancy is a prime moment to intervene and support women to reduce or quit smoking due to the impact of tobacco and nicotine on the pregnancy and baby:

• Motivational interviewing used by clinicians and community providers who can help move a woman along in their stage of readiness to quit
• Consistent advice against tobacco use in pregnancy from health care providers, community agencies, and other intersection points for pregnant and newly parenting women
• Facilitated referral to 802Quits
• Quitline protocols tailored to pregnancy
• Strategic communications targeted at this population and their prenatal providers
• Financial incentives
• Implementation of the 5As: The 5 A’s approach is a brief, goal-directed way to more effectively address tobacco use with patients with the goal of meeting tobacco users’ needs in terms of readiness to quit:
  • Ask: About tobacco use every time
  • Advise: Urge tobacco users to quit
  • Assess: Determine willingness to make a quit attempt
  • Assist: Provide help to move the individual toward a successful quit attempt
  • Arrange: Follow-up contact

• 802Quits has a special protocol for new and expecting mothers, based in the research. Registrants work with a supportive Pregnancy Quit Coach during and after pregnancy. The program includes: 9 calls with a personal coach, text messaging support available for free, free Nicotine Replacement Therapy with doctor’s prescription, and financial incentives for each completed counseling call (up to $65).
• Vermont’s Nurse Family Partnership (NFP) program has demonstrated highly successful outcomes in referring families to 802Quits: 100% of NFP clients that smoke are referred to 802Quits. NFP is an evidence based home visiting model using nurse home visitors that work with women throughout pregnancy until the child is age 2.
   

Women who smoke during pregnancy are more likely than nonsmokers to have an ectopic pregnancy, vaginal bleeding, placental abruption, placenta previa or stillbirth.  Babies born to women who smoke during pregnancy are more likely to be of low birthweight or born prematurely, increasing their risk of serious health problems.