Need: Smoking during pregnancy increases the risks of complications during pregnancy and adverse birth outcomes. Disparities in maternal smoking exist among underserved and marginalized pregnant women. Low-income pregnant women in rural residency have disproportionally higher smoking rates before, during, and after pregnancy. The Brazos Valley (BV) Region in East-Central Texas consists of seven rural counties. The pregnancy smoking rates in the BV Region is approximately two to three times higher than the state as a whole. Nevertheless, only flyers and referrals to the state quit-line are currently offered, which have yielded a low prenatal cessation rate in the BV Region. To address such di...

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Need: Smoking during pregnancy increases the risks of complications during pregnancy and adverse birth outcomes. Disparities in maternal smoking exist among underserved and marginalized pregnant women. Low-income pregnant women in rural residency have disproportionally higher smoking rates before, during, and after pregnancy. The Brazos Valley (BV) Region in East-Central Texas consists of seven rural counties. The pregnancy smoking rates in the BV Region is approximately two to three times higher than the state as a whole. Nevertheless, only flyers and referrals to the state quit-line are currently offered, which have yielded a low prenatal cessation rate in the BV Region. To address such disparities and urgent needs, this resubmitted project proposes to develop and implement an evidence-based, comprehensive, multi-component, and bilingual (English and Spanish) program to promote the accessibility of smoking cessation services and prevention of secondhand smoke (SHS) exposure among rural, low-income pregnant women and their families in the BV Region. Moreover, to create and promote a sustainable healthcare system to serve low-income pregnant women and their household smokers, we will provide training to 180 health professionals in clinical and community settings to establish a "prenatal smoking cessation services competent" health professional workforce in the BV Region. Overall Project Strategy: We will collaborate with nine WIC and prenatal care clinics serving rural, low-income, and uninsured/underinsured pregnant women in the BV Region to implement our evidence-based smoking cessation program. Specifically, the components of the project include: (1) developing a tablet-based smoking screening tool, which will be integrated into the routine practices of WIC and prenatal care clinics; (2) establishing a proactive community health worker (CHW)-initiated referral and assessment system; (3) delivering an evidence-based Baby & Me Tobacco Free (BMTF) program to rural, low-income pregnant smokers and their household smokers; (4) conducting a "Smoke-free Home" intervention with non-smoking pregnant women living with household smokers to reduce their SHS exposure during pregnancy through the establishment of a smoking ban at home; (5) providing case management and personalized navigation services by CHWs to improve the accessibility of usual care and smoking cessation resources and services for all participants; and (6) holding three half-day face-to-face training workshops and offering online training for health professionals annually to develop a prenatal smoking cessation services workforce in the BV Region. Specific Goals: Within three project years, we will (1) develop a comprehensive, evidence-based, and multi-component smoking cessation program for low-income rural pregnant smokers and their household smokers as well as non-smoking pregnant women living with household smokers in the BV Region of Texas (Goal 1); (2) implement this comprehensive smoking cessation program by targeting 843 rural, low-income pregnant smokers and their household smokers as well as 1,366 non-smoking pregnant women living with household smokers (Goal 2); and (3) establish a "prenatal smoking cessation services competent" health professional workforce in Texas by training 180 health professionals in clinical and community settings in the BV Region (Goal 3). Significance and Impact: This project will increase the accessibility of evidence-based prenatal smoking cessation and SHS exposure prevention services among rural, low-income women and their household smokers. It will reduce the smoking rate during pregnancy and the SHS exposure among pregnant women and their household smokers, lead to a better health outcome for pregnant women, decrease infant morbidity and mortality, and reduce associated medical costs. Moreover, this evidence-based program can be adopted to serve more low-income pregnant women and their families in other rural areas of Texas.

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