Health education for pregnant smokers: its behavioral impact and cost benefit

Am J Public Health. 1993 Feb;83(2):201-6. doi: 10.2105/ajph.83.2.201.


Objectives: A randomized trial (the Birmingham Trial II) was conducted to evaluate the behavioral impact of health education methods among 814 female smokers at four public health maternity clinics.

Methods: Four hundred patients were randomly assigned to an Experimental (E) Group, and 414 were assigned to a Control (C) Group. Self-reports and saliva cotinine tests confirmed smoking status at the first visit, at midpregnancy, and at end of pregnancy.

Results: The E Group exhibited a 14.3% quit rate and the C Group an 8.5% quit rate. A Historical Comparison (C) Group exhibited a 3.0% quit rate. Black E and C Group patients had higher quit rates than White E and C Group patients. A cost-benefit analysis found cost-to-benefit ratios of $1:$6.72 (low estimate) and $1:$17.18 (high estimate) and an estimated savings of $247,296 (low estimate) and $699,240 (high estimate).

Conclusion: Health education methods are efficacious and cost beneficial for pregnant smokers in public health maternity clinics.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Female
  • Health Behavior
  • Health Education* / economics
  • Humans
  • Maternal Health Services / economics
  • Patient Compliance
  • Pregnancy / psychology*
  • Program Evaluation
  • Prospective Studies
  • Random Allocation
  • Sensitivity and Specificity
  • Smoking Cessation* / economics
  • Smoking Cessation* / psychology