The widespread availability of smoking cessation services in Healthy Start projects reflects a growing recognition that smoking during pregnancy is linked to low birthweight and infant mortality. Three-fourths (73 percent) of the Healthy Start projects provided smoking cessation services in 2003. Among the 69 grantees providing these services, the services most frequently offered were case management that included cessation counseling (77 percent), regular reminders by Healthy Start staff during each visit (71 percent), smoking cessation classes (52 percent), or behavioral support counseling (52 percent). Fewer grantees provided psychosocial counseling (22 percent) or pharmacological therapies (6 percent). It is not clear from these data whether some of these services, such as pharmacotherapy, may be available from other providers in the community. Moreover, the survey did not gather information on the intensity and duration of treatment (such as cessation counseling and reminders) during case management visits.

About one-fifth of the grantees (19 percent) indicated they relied on other strategies. Several grantees reported using the “4 R’s” to motivate smokers to quit (relevance, risks, rewards, and repetition). Other interventions included secondhand smoke reduction strategies, provision of a self-help guide developed by the grantee or another organization, or life skills education classes.

Grantees with a predominantly nursing case management staff offered a broader mix of smoking cessation services than other grantees, providing an average of 3.3 types of services, compared to 2.3 for those with a predominantly social work staff, 1.9 for multidisciplinary staff, and 1.6 for lay/ paraprofessional staff (data not shown). In particular, grantees with predominantly nursing staff were more likely to offer behavioral support counseling (79 percent) than those relying on social work staff (56 percent), multidisciplinary staff (43 percent), and lay/paraprofessional staff (33 percent).