This project, First Breath Families (FBF), aimed to fill the gap in access to perinatal smoking cessation services for low-income Wisconsin women, thereby improving the health of mothers, infants and families. FBF is a comprehensive cessation support system for pregnant women and household smokers and supports them from pregnancy through six months postpartum. Smoking during pregnancy is the leading preventable cause of adverse birth outcomes, and in Wisconsin, 15 percent of women report smoking during their pregnancies. Despite the risks associated with smoking, many women who quit during pregnancy face high postpartum relapse rates due to social challenges and lack of access to cessation services.
FBF successfully expanded its evidence-based perinatal tobacco cessation program across Wisconsin, engaging 2,300 pregnant and postpartum individuals. The program achieved substantial progress in smoking cessation, increasing rates from 26 percent of participants in 2019 to 56 percent in 2023. Additionally, the program has trained 1,388 providers in tobacco screening and intervention, with high satisfaction and confidence reported among newly recruited providers. Finally, FBF expanded its reach through over 50 new partnerships, ensuring broad accessibility to cessation services statewide, including coverage in all Wisconsin counties.
The Challenge
Smoking during pregnancy is the leading preventable cause of adverse birth outcomes, including prematurity, low birth weight and infant mortality. In Wisconsin, the infant mortality rate for smokers is significantly higher at 9.4 per thousand live births compared to 5.7 for non-smokers, and 15 percent of women reported smoking during their pregnancies in 2015. Additionally, one in four children in Wisconsin are exposed to second-hand smoke, contributing to health problems like asthma. Smoke exposure disproportionately affects children from poor households where exposure rates are ten times higher than more affluent counterparts.
Despite the risks associated with smoking, many women who quit during pregnancy face exceptionally high postpartum relapse rates, ranging from 70 to 85 percent, due to challenges like stress, lack of social support and living with other smokers. Furthermore, changes in health care systems and reduced enrollment in prenatal care coordination programs have limited access to cessation services. In response to these challenges, Wisconsin Women’s Health Foundation has developed and launched First Breath Families (FBF), a comprehensive cessation support system that integrates local public health departments and clinical settings, ensuring personalized counseling for pregnant women and household smokers from pregnancy through six months postpartum.
Project Goals
The goal of FBF was to expand the program statewide and fill the gap in access to perinatal smoking cessation services for low-income Wisconsin women, thereby improving the health of mothers, infants and families. This goal was addressed through a two-pronged approach: first, expanding a highly effective prenatal smoking cessation program that included postpartum home visits and second, working to secure sustainable funding via state budget allocations, administrative rule changes and public and private partnerships.
Results
FBF successfully expanded its evidence-based perinatal tobacco cessation program throughout Wisconsin, engaging 2,300 pregnant and postpartum individuals and 398 caregivers since its launch. Six-month postpartum surveys from participants revealed that 88 percent of participants reported learning new information and 85 percent reported learning new skills as a result of FBF. The program saw significant progress in smoking cessation over the course of the project, beginning with 26 percent of participants reporting being smoke-free in 2019 and advancing to 56 percent of participants in 2023. These outcomes underscore the program’s effectiveness as well as its impact on participants’ health outcomes.
Since its inception, the program has trained 1,388 providers in comprehensive tobacco screening, education and intervention using the Ask-Advise-Refer (AAR) model. Of the 650 newly recruited providers, 96 percent reported being satisfied with their training and 99 percent indicated they were confident in their ability to implement FBF referrals into their practice. FBF also increased accessibility to services by forming more than 50 new partnerships since 2018, expanding network sites to include OB/GYN clinics, WIC sites, prenatal care coordination programs, local health departments, Federally Qualified Health Centers, tribal health clinics and others. The network includes at least one partner site in each of Wisconsin’s counties and in 2023, FBF reached about 25 percent of all pregnant tobacco users in the state.
