Reducing Tobacco Use Among Pregnant WIC Clients by Increasing Enrollment in Tobacco Cessation Programs


Impact Statement: 
A local health department increased early enrollment of pregnant women in smoking cessation programs to reduce risks of pregnancy complications, premature delivery, and their infants being low-birth weight, stillborn, or dying from SIDS.

Women who smoke during pregnancy are at increased risk of pregnancy complications and premature delivery, and their infants are at risk of low birth weight, stillbirth, or sudden infant death syndrome (SIDS). Comparable with national data, 10.7% of women smoke at “any time during pregnancy” within the Central District Health Department (CDHD) service area (Idaho Vital Statistics 2011, Idaho Department of Health and Welfare, Division of Public Health, Bureau of Vital Records and Health Statistics, February 2013). Women, Infants, and Children (WIC) clients are at higher risk of smoking because of their low socioeconomic status and lower education levels. CDHD current smoking cessation control efforts targeting pregnant WIC clients who smoke enroll only half of reported WIC tobacco users in the smoking cessation program. However, once enrolled, more than half quit or reduced tobacco use. CDHD conducted a quality improvement (QI) process to reach more pregnant women by enrolling them in the smoking cessation program.

Using the Plan, Do, Study, Act (PDSA) improvement model, CDHD analyzed the current enrollment approach and worked to improve it. To learn about the current process, CDHD conducted focus groups with pregnant WIC clients who use tobacco and involved WIC staff in brainstorming and completing a process flowchart and a fishbone cause-and-effect diagram. This work provided information about barriers and solutions to enrollment and participation in the program. After reviewing all data, WIC staff identified three top solutions, and the QI team selected reducing paperwork and streamlining the referral process as the most feasible solutions to pilot. Three enrollment documents were merged into one, and staff added a fax referral to the Idaho QuitLine as a resource. Solutions were tested, and results showed that WIC staff required additional training on promoting client enrollment in the modified process (training was provided). By the end of the project, staff knowledge improved. Clients received enhanced tobacco cessation services through referral to QuitLine. Staff plan to expand the improved enrollment process and QuitLine fax referral to all WIC clinics within the CDHD area.

Organization that conducted the QI initiative: 

Graff, J. Public Health Quality Improvement Exchange. Reducing Tobacco Use Among Pregnant WIC Clients by Increasing Enrollment in Tobacco Cessation Programs. Tue, 03/04/2014 - 10:30. Available at Accessed April 20, 2024.

Submission Status: 
1 user has voted.


bethvw's picture
Submitted by bethvw on

Great project! Reducing smoking during pregnancy is so important for future maternal and child health. In KY our rates are very high. Are you willing to share your one-page barriers handout that was developed during this project? You have inspired me to take a look at our WIC processes for referring and counseling pregnant smokers.

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Public Health Services Manager
Clark County Health Department, KY