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


  • Windsor, R.A.
  • Lowe, J.B.
  • Perkins, L.L.
  • Smith-Yoder, D.
  • Artz, L.
  • Crawford, M.
  • Amburgy, K.
  • Boyd Jr., N.R.


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.

Suggested Citation

  • Windsor, R.A. & Lowe, J.B. & Perkins, L.L. & Smith-Yoder, D. & Artz, L. & Crawford, M. & Amburgy, K. & Boyd Jr., N.R., 1993. "Health education for pregnant smokers: Its behavioral impact and cost benefit," American Journal of Public Health, American Public Health Association, vol. 83(2), pages 201-206.
  • Handle: RePEc:aph:ajpbhl:1993:83:2:201-206_0

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    Cited by:

    1. Andrew D. Racine & Cristina Yunzal-Butler, 2007. "Reassessing the WIC Effect: Evidence from the Pregnancy Nutrition Surveillance System," NBER Working Papers 13441, National Bureau of Economic Research, Inc.
    2. Ted Joyce & Andrew Racine & Cristina Yunzal-Butler, 2008. "Reassessing the WIC effect: Evidence from the Pregnancy Nutrition Surveillance System," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 27(2), pages 277-303.
    3. Douglas Almond & Kenneth Y. Chay & David S. Lee, 2005. "The Costs of Low Birth Weight," The Quarterly Journal of Economics, Oxford University Press, vol. 120(3), pages 1031-1083.
    4. Ji Yan & Peter A. Groothuis, 2013. "Timing of Prenatal Smoking Cessation or Reduction and Infant Birth Weight: Evidence from the United Kingdom Millennium Cohort Study," Working Papers 13-16, Department of Economics, Appalachian State University.
    5. Cristina Yunzal-Butler & Theodore J. Joyce & Andrew D. Racine, 2009. "Maternal Smoking and the Timing of WIC Enrollment," NBER Working Papers 14728, National Bureau of Economic Research, Inc.

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