Focus on Pediatrics: Phone counseling aids stop-smoking efforts

Program designed for expectant mothers

When a pregnant woman smokes the nicotine and carbon monoxide she inhales from the cigarette reaches the baby through the placenta and prevents the fetus from getting the nutrients and oxygen needed to grow, according to the New York City-based American Lung Association.

The association estimates that 20%-30% of low-birth weight babies, up to 14% of pre-term deliveries, and 10% of all infant deaths can be linked to maternal smoking during pregnancy.

Although many women may stop smoking during their pregnancy, they frequently begin again once the baby is born, and secondhand smoke is harmful to their child. Children whose mothers smoke more than 10 cigarettes a day are twice as likely to develop asthma.

While the statistics about the effects of smoking on an unborn child are a good incentive to quit smoking, it’s a very difficult habit to break. That’s why Plymouth Meeting, PA-based SmokeStoppers, a company that markets telephone counseling smoking cessation programs, designed one specifically for pregnant smokers.

It’s patterned after the company’s standard program, where smokers who are enrolled receive a series of scheduled counseling calls coupled with a 21-day printed or web-based tutorial that teaches strategies on dealing with nicotine withdrawals.

"It’s a step-by-step, one-day-at-a-time process to get people to quit smoking and keep them smoke-free," says George Nice, president of SmokeStoppers.

Those enrolled in the prenatal counseling program receive 11 calls over a 15-month period. Up to six counseling calls are placed during the first and second trimester. The relapse prevention counseling lasts to six months postpartum.

When people first enroll in the telephone counseling program, a counselor learns their health history, their smoking history, their addiction level, their self-efficacy, and their program preferences to determine what is most likely to help them quit on a long-term basis.

They receive either the printed QuitKit or a password for the web-based program. Both follow the same one-day-at-a-time format. However, smokers can read through the entire 21-day printed version of the program in one sitting even though they are advised not to. With the Internet program, enrollees cannot work ahead because they receive the action plan day by day. They can review previous plans.

Another benefit of the Internet version is that the content can be more closely tailored to the individual because they fill out a questionnaire when they first log onto the site. "If a woman tells us she is pregnant, she will get information that relates to pregnancy and smoking throughout the 21 days, and we will use that as a primary motivator for her to quit smoking," says Nice.

All the telephone counseling calls are outbound calls from the counselor to the participant’s home or office, and are scheduled in advance. Participants also have access to an inbound toll-free number they can call anytime. They leave their name and their counselor returns their call within 24-hours.

SmokeStoppers does not market its program directly to consumers, but contracts with organizations that will offer it free of charge to the smoker, such as companies and health plans. "We have found that by and large, smokers — maternity or otherwise — will not pay for a smoking cessation program," says Nice.

The cost for the prenatal telephone counseling program is $225 per person. To help determine the success rate of the program, SmokeStoppers is working on a pilot project with a large health plan to obtain valid outcomes on its maternity population.

"We suspect the success rate for this program will be higher than a normal program because pregnant smokers have a strong motivation to quit and will have greater success," says Nice. For corporate clients, the 12-month quit rate in general is 35%-40%.


For more information about the SmokeStoppers prenatal telephone counseling program, contact:

  • George Nice, President, SmokeStoppers. 4070 Butler Pike, Suite 800, Plymouth Meeting, PA 19462. Telephone: (800) 697-7221. E-mail: