A Pregnant Woman’s Self-Help Guide to Quit Smoking

Updated: Feb 09, 2018
Evidence Rating:
Suggestive Tier


  • Program:

    In this program, health counselors in public maternity clinics teach pregnant women how to use a 7-10 day self-directed smoking cessation guide. The program costs approximately $16 per patient and is provided as a supplement to clinics’ usual care.

  • Evaluation Methods:

    This program has been evaluated in six well-conducted randomized controlled trials (RCTs).

  • Key Findings:

    A sizable increase in the quit rate: 13.9% of women assigned to the program quit smoking in the last 4-5 months of their pregnancy, compared with 8.3% of the women assigned to the control group. In almost all of the RCTs, these effects were statistically significant.

  • Other:

    One limitation in the evidence is that none of the studies reported on birth outcomes (e.g., miscarriage rates, birth weight, gestational age) or early childhood outcomes (e.g., cognitive development, health). Thus, the final impact on child well-being is unknown – and, specifically, whether smoking cessation during the second half of pregnancy (after mothers had smoked during the first half of pregnancy) improves child well-being in a meaningful way.

This educational program for pregnant smokers was provided by health counselors in public maternity clinics. It consisted of a 10-20 minute session during which counselors taught women how to use a 7-10 day self-directed smoking cessation guide (A Pregnant Woman’s Self-Help Guide to Quit Smoking). The program cost approximately $16 per patient (2017 dollars), and was provided in addition to clinics’ usual care, which, in the study clinics described below, typically consisted of brief discussion of the risks of smoking during a nurse-led prenatal class, educational pamphlets, and information on local resources providing quitting assistance.

The Guide is currently out-of-print; the author and program developer is Richard Windsor.

To see our full evidence summary:
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Study 1:

Windsor, Richard A., Gary Cutter, Joyce Morris, Yoland Reese, Brynda Manzella, Edward E. Bartlett, Carole Samuelson, and Debra Spanos. “The Effectiveness of Smoking Cessation Methods for Smokers in Public Health Maternity Clinics: A Randomized Trial.” The American Journal of Public Health, 1985, vol. 75, pp. 1389-1392.

Study 2:

Windsor, Richard A., John B. Lowe, Laura L. Perkins, Dianne Smith-Yoder, Lynn Artz, Myra Crawford, Kim Amburgy, and Neal Richard Boyd. “Health Education for Pregnant Smokers: Its Behavioral Impact and Cost Benefit.” The American Journal of Public Health, February 1993, vol. 83, no. 2, pp. 201-206.

Study 3:

Hartmann, Katherine E., John M. Thorpe, Laurie Pahel-Short, and Matthew A. Koch. “A Randomized Controlled Trial of Smoking Cessation Intervention in Pregnancy in an Academic Clinic.” Obstetrics and Gynecology, 1996, vol. 87, pp. 621-626.

Study 4:

O’Connor, Annette M., Barbara L. Davies, Corinne S. Dulberg, P. Lynn Buhler, Claudette Nadon, Beverly H. McBride, and Ronald J. Benzie. “Effectiveness of a Pregnancy Smoking Cessation Program.” Journal of Obstetrics, Gynaecology, and Neonatal Nursing, 1992, vol. 21, pp. 385-392.

Study 5:

Valbo, Annelill and Gro Nylander. “Smoking Cessation in Pregnancy: Intervention Among Heavy Smokers.” Acta Obstetrica et Gynecogica Scandanavia, 1994, vol. 73, pp. 215 – 219.

Study 6:

Windsor, Richard A., Lesa Woodby, Thomas Miller, and Michael Hardin. “Effectiveness of Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Methods in Medicaid-Supported Prenatal Care: Trial III.” Health Education & Behavior, 2011, vol. 38, no. 4, pp. 412-422.

Other Studies:

Gielen, Andrea C., Richard A. Windsor, Ruth R. Faden, Patricia O’Campo, John Repke, and Mary V. Davis. “Evaluation of a Smoking Cessation Intervention for Pregnant Women in an Urban Prenatal Clinic.” Health Education Research, 1997, vol. 12, pp. 247-254.

Hjalmarson, A. I. M., L. Hahn, and B. Svanberg. “Stopping Smoking in Pregnancy: Effect of a Self-Help Manual in a Controlled Trial.” British Journal of Obstetrics and Gynaecology, 1991, vol. 98, pp. 260-264.