title: Home visiting and perinatal smoking: a mixed-methods exploration of cessation and harm reduction strategies.
abstract: Home visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied.
  
  
  
  Mixed methods approach using a retrospective cohort of propensity score matched home visiting clients and local-area comparison women with first births between 2008-2014 in a large Northeast state. Multivariable logistic and linear regression estimated third trimester prenatal tobacco smoking cessation and reduction. Additionally, qualitative interviews were conducted with 76 home visiting clients.
  
  
  
  A program effect was seen for smoking cessation such that clients who smoked less than ten cigarettes per day and those who smoked 20 or more cigarettes per day during the first trimester were more likely to achieve third trimester cessation than comparison women (p <0.01 and p = 0.01, respectively). Only for heavy smokers (20 or more cigarettes during the first trimester) was there a significant reduction in number of cigarettes smoked by the third trimester versus comparison women (p = 0.01). Clients expressed the difficulty of cessation, but addressed several harm-reduction strategies including reducing smoking in the house and wearing a smoking jacket. Clients also described smoking education that empowered them to ask others to not smoke or adopt other harm reducing behaviors when around their children.
  
  
  
  While a significant impact on smoking cessation was seen, this study finds a less-clear impact on smoking reduction among women in home visiting programs. As home visiting programs continue to expand, it will be important to best identify effective ways to support tobacco-related harm reduction within vulnerable families.
authors: PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA. griffish@email.chop.edu.
authors: Heather
authors: H
authors: Griffis
authors: PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA.|Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors: Meredith
authors: M
authors: Matone
authors: PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA.
authors: Katherine
authors: K
authors: Kellom
authors: PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA.
authors: Erica
authors: E
authors: Concors
authors: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors: William
authors: W
authors: Quarshie
authors: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Benjamin
authors: B
authors: French
authors: Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors: David
authors: D
authors: Rubin
authors: Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors: Peter F
authors: PF
authors: Cronholm
mesh_terms: D000328:Adult; D005260:Female; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D009511:New England; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000523:psychology*; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000517:prevention & control; D057216:Propensity Score; D012189:Retrospective Studies; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D062789:Tobacco Products / Q000706:statistics & numerical data
keywords: Home visiting; Maternal and child health; Smoking cessation and reduction